Provider First Line Business Practice Location Address:
118 S MIDLAND 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:
83686-2601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-442-1000
Provider Business Practice Location Address Fax Number:
208-442-1091
Provider Enumeration Date:
01/12/2021