Provider First Line Business Practice Location Address:
3551 E. OVERLAND RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERIDIAN
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-884-1333
Provider Business Practice Location Address Fax Number:
208-489-4015
Provider Enumeration Date:
02/07/2007