Provider First Line Business Practice Location Address:
21 JEFFERSON WAY, SUITE 202
Provider Second Line Business Practice Location Address:
PSYCHIATRY
Provider Business Practice Location Address City Name:
KETCHIKAN
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-228-7660
Provider Business Practice Location Address Fax Number:
907-228-8336
Provider Enumeration Date:
12/18/2007