Provider First Line Business Practice Location Address:
715 WEST COMSTOCK
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:
83651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-463-1732
Provider Business Practice Location Address Fax Number:
208-882-3369
Provider Enumeration Date:
09/10/2007