Provider First Line Business Practice Location Address:
2442 TONGASS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KETCHIKAN
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99901-5928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-885-2280
Provider Business Practice Location Address Fax Number:
907-885-6613
Provider Enumeration Date:
12/30/2020