Provider First Line Business Practice Location Address:
223 E AMITY 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:
83686-5707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-461-3035
Provider Business Practice Location Address Fax Number:
208-466-0693
Provider Enumeration Date:
09/20/2006