Provider First Line Business Practice Location Address:
801 S RISING SUN DR
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:
83686-6009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-466-6161
Provider Business Practice Location Address Fax Number:
208-298-0633
Provider Enumeration Date:
08/12/2006