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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-494-2355
Provider Business Practice Location Address Fax Number:
907-494-2356
Provider Enumeration Date:
05/21/2007