Provider First Line Business Practice Location Address:
570 UNIVERSITY AVE
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:
99709-3641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-479-2206
Provider Business Practice Location Address Fax Number:
907-479-6847
Provider Enumeration Date:
08/05/2006