Provider First Line Business Practice Location Address:
6270 FORD-WELLPINIT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLPINIT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99040-0390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-258-4535
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2006