Provider First Line Business Practice Location Address:
51003 MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KOBUK
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99751-0003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-948-2221
Provider Business Practice Location Address Fax Number:
907-948-2199
Provider Enumeration Date:
11/23/2011