Provider First Line Business Practice Location Address:
744 3RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KOTZEBUE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99752-0051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-442-3472
Provider Business Practice Location Address Fax Number:
907-442-2196
Provider Enumeration Date:
04/25/2007