Provider First Line Business Practice Location Address:
1640 COWLES ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99701-5925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-458-5380
Provider Business Practice Location Address Fax Number:
907-458-5379
Provider Enumeration Date:
08/28/2008