Provider First Line Business Practice Location Address:
16730 N MARKET PLACE 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:
83687-7909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-466-4600
Provider Business Practice Location Address Fax Number:
208-461-9236
Provider Enumeration Date:
07/14/2005