Provider First Line Business Practice Location Address:
1060 GAFFNEY RD STE 7440
Provider Second Line Business Practice Location Address:
COMMANDER USA MEDDAC AK MCUC QM (ATTN CREDENTIALS)
Provider Business Practice Location Address City Name:
FT WAINWRIGHT
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99703-5001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-353-5418
Provider Business Practice Location Address Fax Number:
907-353-4847
Provider Enumeration Date:
12/19/2006