Provider First Line Business Practice Location Address:
175 S. MIDDLETON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAMPA
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-546-3396
Provider Business Practice Location Address Fax Number:
208-546-3338
Provider Enumeration Date:
07/21/2014