Provider First Line Business Practice Location Address:
404 N HORTON 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:
83651-6541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-466-9292
Provider Business Practice Location Address Fax Number:
208-463-7585
Provider Enumeration Date:
07/25/2006