Provider First Line Business Practice Location Address:
217 W GEORGIA AVE STE 120
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:
83686-6812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-498-1760
Provider Business Practice Location Address Fax Number:
208-498-1761
Provider Enumeration Date:
05/24/2006