Provider First Line Business Practice Location Address:
BLDG 4066 602 STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WAINWRIGHT
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-361-6059
Provider Business Practice Location Address Fax Number:
907-360-6151
Provider Enumeration Date:
12/01/2006