Provider First Line Business Practice Location Address:
1867 AIRPORT WAY
Provider Second Line Business Practice Location Address:
SUITE 160B
Provider Business Practice Location Address City Name:
FAIRBANKS
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:
907-455-7285
Provider Business Practice Location Address Fax Number:
907-455-7280
Provider Enumeration Date:
04/03/2007