Provider First Line Business Practice Location Address:
626 2ND ST STE 201A
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:
99701-3466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-328-9073
Provider Business Practice Location Address Fax Number:
907-238-9074
Provider Enumeration Date:
01/30/2007