Provider First Line Business Practice Location Address:
11035 KARCHER 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:
83651-8200
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:
208-302-6655
Provider Enumeration Date:
08/19/2014