Provider First Line Business Practice Location Address:
2175 UNIVERSITY AVE S
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:
99709-4927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-452-8251
Provider Business Practice Location Address Fax Number:
907-459-3810
Provider Enumeration Date:
05/14/2019