Provider First Line Business Practice Location Address:
11035 W. KARCHER ROAD
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:
208-302-6600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2011