Provider First Line Business Practice Location Address:
11921 E PALMER WASILLA HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMER
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99645-8833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-544-9552
Provider Business Practice Location Address Fax Number:
360-249-7465
Provider Enumeration Date:
06/23/2026