Provider First Line Business Practice Location Address:
4424 E FLAMINGO AVE
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
NAMPA
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83687
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-288-4700
Provider Business Practice Location Address Fax Number:
208-288-4720
Provider Enumeration Date:
11/02/2005