Provider First Line Business Practice Location Address:
211 16TH AVE N
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:
83687-4058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-467-4431
Provider Business Practice Location Address Fax Number:
208-467-7684
Provider Enumeration Date:
07/06/2008