Provider First Line Business Practice Location Address:
3504 INDUSTRIAL AVE
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99701-7376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-388-3221
Provider Business Practice Location Address Fax Number:
907-459-8201
Provider Enumeration Date:
12/17/2010