Provider First Line Business Practice Location Address:
1717 WEST COWLES STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-378-1997
Provider Business Practice Location Address Fax Number:
907-458-3811
Provider Enumeration Date:
12/23/2008