Provider First Line Business Practice Location Address:
PO BOX 61
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:
99040-0061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-701-5525
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2025