Provider First Line Business Practice Location Address:
PO BOX 225
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:
83653-0225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-986-9596
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/03/2026