Provider First Line Business Practice Location Address:
6228 OLD SCHOOL 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-606-2764
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/27/2023