Provider First Line Business Practice Location Address:
13 N ADAMS 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:
83651-2189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-724-2576
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2025