Provider First Line Business Practice Location Address:
900 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:
83687-8596
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-401-9639
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/26/2007