Provider First Line Business Practice Location Address:
225 WENDELL ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
FAIR BANKS
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:
907-455-4140
Provider Business Practice Location Address Fax Number:
907-455-4119
Provider Enumeration Date:
06/10/2006