Provider First Line Business Practice Location Address:
701 UNIVERSITY AVE
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:
99709-3646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-452-7223
Provider Business Practice Location Address Fax Number:
907-452-1293
Provider Enumeration Date:
05/15/2013