Provider First Line Business Practice Location Address:
250 CUSHMAN ST
Provider Second Line Business Practice Location Address:
SUITE 4F
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99701-4640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-479-7242
Provider Business Practice Location Address Fax Number:
907-479-6088
Provider Enumeration Date:
05/16/2007