Provider First Line Business Practice Location Address:
1717 W. COWLES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK- ALASKA
Provider Business Practice Location Address Postal Code:
99701
Provider Business Practice Location Address Country Code:
UM
Provider Business Practice Location Address Telephone Number:
907-452-8251
Provider Business Practice Location Address Fax Number:
907-459-3950
Provider Enumeration Date:
03/27/2015