Provider First Line Business Practice Location Address:
16818 N MARKETPLACE 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:
83687-5140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-321-4000
Provider Business Practice Location Address Fax Number:
208-855-0157
Provider Enumeration Date:
03/10/2017