Provider First Line Business Practice Location Address:
600 UNIVERSITY AVE (PHYSICAL ONLY)
Provider Second Line Business Practice Location Address:
600 UNIVERSITY AVE. (PHYSICAL ONLY) SUITE 1B
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99701-3643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-451-6888
Provider Business Practice Location Address Fax Number:
907-451-6885
Provider Enumeration Date:
05/24/2007