Provider First Line Business Practice Location Address:
2311 E ARUBA 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:
83686-1292
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-461-3203
Provider Business Practice Location Address Fax Number:
208-461-3203
Provider Enumeration Date:
09/25/2009