Provider First Line Business Practice Location Address:
6973 ZUCKERT AVENUE
Provider Second Line Business Practice Location Address:
176TH MEDICAL GROUP
Provider Business Practice Location Address City Name:
ELMENDORF/ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-551-0435
Provider Business Practice Location Address Fax Number:
907-551-0431
Provider Enumeration Date:
03/15/2012