Provider First Line Business Practice Location Address:
850 W. ST. LUKE'S DR.
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
NAMPA
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83687
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-706-9025
Provider Business Practice Location Address Fax Number:
208-489-4300
Provider Enumeration Date:
11/27/2012