Provider First Line Business Practice Location Address:
337 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:
208-467-7889
Provider Business Practice Location Address Fax Number:
208-467-7800
Provider Enumeration Date:
09/02/2006