Provider First Line Business Practice Location Address:
565 UNIVERSITY AVE.
Provider Second Line Business Practice Location Address:
STE. #4
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99709-3688
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-978-4978
Provider Business Practice Location Address Fax Number:
800-881-6187
Provider Enumeration Date:
03/12/2007