Provider First Line Business Practice Location Address:
50 2ND 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:
83651-3700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-465-2836
Provider Business Practice Location Address Fax Number:
208-465-2833
Provider Enumeration Date:
03/16/2011