Provider First Line Business Practice Location Address:
436 5TH & TED STEVENS WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KOTZEBUE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99752-0043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-442-3321
Provider Business Practice Location Address Fax Number:
907-442-7250
Provider Enumeration Date:
12/26/2006