Provider First Line Business Practice Location Address: 
1060 GAFFNEY RD
    Provider Second Line Business Practice Location Address: 
BASSETT ARMY COMMUNITY HOSPITAL
    Provider Business Practice Location Address City Name: 
FT WAINWRIGHT
    Provider Business Practice Location Address State Name: 
AK
    Provider Business Practice Location Address Postal Code: 
99703-5001
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
907-353-5418
    Provider Business Practice Location Address Fax Number: 
907-353-4845
    Provider Enumeration Date: 
02/08/2006