Provider First Line Business Practice Location Address:
5534 NORTH TONGASS HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KETCHIKAN
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99901-5669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-225-4325
Provider Business Practice Location Address Fax Number:
907-531-7369
Provider Enumeration Date:
01/28/2008