Provider First Line Business Practice Location Address:
4400 E FLAMINGO 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:
83687-9203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-288-4660
Provider Business Practice Location Address Fax Number:
208-288-4664
Provider Enumeration Date:
08/19/2006