Provider First Line Business Practice Location Address:
343 W IOWA AVE
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:
83686-2856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-467-0001
Provider Business Practice Location Address Fax Number:
208-466-2205
Provider Enumeration Date:
08/12/2006