Provider First Line Business Practice Location Address:
5875 E FRANKLIN RD
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:
83687-5020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-461-8718
Provider Business Practice Location Address Fax Number:
208-461-8720
Provider Enumeration Date:
10/03/2006