Provider First Line Business Practice Location Address:
6203 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-258-7766
Provider Business Practice Location Address Fax Number:
509-258-9453
Provider Enumeration Date:
11/18/2006