Provider First Line Business Practice Location Address:
122 1ST AVE
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99701-4803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-698-0290
Provider Business Practice Location Address Fax Number:
406-698-0290
Provider Enumeration Date:
02/24/2007