Provider First Line Business Practice Location Address:
16439 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:
83687-5018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-800-6003
Provider Business Practice Location Address Fax Number:
208-461-5202
Provider Enumeration Date:
07/28/2015