Provider First Line Business Practice Location Address:
1327 KALAKAKET ST
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:
99709-4917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-452-4517
Provider Business Practice Location Address Fax Number:
907-452-4263
Provider Enumeration Date:
05/22/2008