Provider First Line Business Practice Location Address: 
127 E EUCLID AVE STE UNIT
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
SPOKANE
    Provider Business Practice Location Address State Name: 
WA
    Provider Business Practice Location Address Postal Code: 
99207-2022
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
808-938-3867
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
04/21/2016