Provider First Line Business Practice Location Address:
MILE 5.9 MENTASTA SPUR ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENTASTA LAKE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-822-3280
Provider Business Practice Location Address Fax Number:
907-822-3944
Provider Enumeration Date:
06/12/2017