Provider First Line Business Practice Location Address: 
306 W 5TH AVE
    Provider Second Line Business Practice Location Address: 
NORTON SOUND HEALTH CORPORATION
    Provider Business Practice Location Address City Name: 
NOME
    Provider Business Practice Location Address State Name: 
AK
    Provider Business Practice Location Address Postal Code: 
99762-0966
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
907-443-4540
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
01/28/2010