Provider First Line Business Practice Location Address:
2136 AIRPORT WAY # 2
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:
99701-4014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-452-5547
Provider Business Practice Location Address Fax Number:
907-452-4481
Provider Enumeration Date:
11/30/2006