Provider First Line Business Practice Location Address:
211 W IOWA AVE
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:
83686-2834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-465-7377
Provider Business Practice Location Address Fax Number:
208-465-7397
Provider Enumeration Date:
05/16/2006