Provider First Line Business Practice Location Address:
1221 3RD AVE
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:
99701-4239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-452-2345
Provider Business Practice Location Address Fax Number:
907-374-3973
Provider Enumeration Date:
05/16/2013