Provider First Line Business Practice Location Address:
144 N. ORCHARD HEIGHTS WAY
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:
83651-8344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-440-6771
Provider Business Practice Location Address Fax Number:
888-647-0695
Provider Enumeration Date:
10/30/2008