TY WATERS

BOISE, ID
NPI1518492388
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207Q00000X Family Medicine
(Licence: ID  MRM-1630)
Enumeration Date2017-04-28
Last Update Date2017-04-28
Business Address
-- TY WATERS
777 N RAYMOND ST
BOISE, ID 83704-9251
Phone number: 208-514-2500
Mailing Address
-- TY WATERS
777 N RAYMOND ST
BOISE, ID 83704-9251
Phone number: 208-514-2500
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