Provider First Line Business Practice Location Address:
460 WEST HUMORIST ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURBANK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-547-8341
Provider Business Practice Location Address Fax Number:
509-547-3533
Provider Enumeration Date:
12/28/2005