Provider First Line Business Practice Location Address:
3758 E AMITY AVE, SUITE 101
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-328-6097
Provider Business Practice Location Address Fax Number:
208-856-1883
Provider Enumeration Date:
03/10/2026