Provider First Line Business Practice Location Address:
45 S BOISE ST
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:
83651-7601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-461-4508
Provider Business Practice Location Address Fax Number:
208-461-7927
Provider Enumeration Date:
02/16/2008