Provider First Line Business Practice Location Address:
1922 LOGAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99508-3281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-222-1980
Provider Business Practice Location Address Fax Number:
907-222-2419
Provider Enumeration Date:
03/24/2007