Provider First Line Business Practice Location Address:
1375 N HAPPY VALLEY RD
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:
83687-5280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-809-2869
Provider Business Practice Location Address Fax Number:
208-809-2868
Provider Enumeration Date:
11/10/2005