Provider First Line Business Practice Location Address:
1929 AIRPORT WAY STE B
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:
99701-4009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-891-7877
Provider Business Practice Location Address Fax Number:
907-917-4887
Provider Enumeration Date:
02/02/2009