Provider First Line Business Practice Location Address:
315 S. KOBUK ST.
Provider Second Line Business Practice Location Address:
SUITE #2
Provider Business Practice Location Address City Name:
SOLDOTNA
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-420-0820
Provider Business Practice Location Address Fax Number:
253-639-4809
Provider Enumeration Date:
04/01/2009