Provider First Line Business Practice Location Address:
1700 W KARCHER RD
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:
83651-1531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-606-0374
Provider Business Practice Location Address Fax Number:
208-318-1837
Provider Enumeration Date:
11/30/2018