Provider First Line Business Practice Location Address:
600 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SUITE 2B
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-371-2240
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2011