Provider First Line Business Practice Location Address:
3504 INDUSTRIAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99701-7376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-452-4673
Provider Business Practice Location Address Fax Number:
907-452-1430
Provider Enumeration Date:
02/21/2007