Provider First Line Business Practice Location Address:
1060 GAFFNEY RD, FORT WAINWRIGHT, AK 99703
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT WAINWRIGHT
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-361-5658
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2009