Provider First Line Business Practice Location Address:
1919 LATHROP ST.
Provider Second Line Business Practice Location Address:
STE 207
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-456-7768
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2006