Provider First Line Business Practice Location Address:
9 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:
83651-2420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-794-4990
Provider Business Practice Location Address Fax Number:
208-278-2282
Provider Enumeration Date:
02/27/2025