Provider First Line Business Practice Location Address:
16548 NORTH FRANKLIN BLVD.
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:
83687
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-461-3070
Provider Business Practice Location Address Fax Number:
208-461-3071
Provider Enumeration Date:
09/04/2013