Provider First Line Business Practice Location Address:
11495 CALLISON STREET
Provider Second Line Business Practice Location Address:
LIFE HOUSE COMMUNITY HEALTH CENTER
Provider Business Practice Location Address City Name:
SUTTON
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99674-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-631-7665
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2006