Provider First Line Business Practice Location Address:
1901 AIRPORT WAY, STE 101
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-374-3063
Provider Business Practice Location Address Fax Number:
907-374-8872
Provider Enumeration Date:
12/18/2006