Provider First Line Business Practice Location Address:
1919 LATHROP ST
Provider Second Line Business Practice Location Address:
STE: 211
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99701-5937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-452-1866
Provider Business Practice Location Address Fax Number:
907-456-1267
Provider Enumeration Date:
10/20/2016