Provider First Line Business Practice Location Address:
1208 11TH ST S
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:
83651-4654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-463-1800
Provider Business Practice Location Address Fax Number:
208-468-9211
Provider Enumeration Date:
08/01/2006