Provider First Line Business Practice Location Address:
1ST MAIN STREET
Provider Second Line Business Practice Location Address:
BOX 09
Provider Business Practice Location Address City Name:
SHAKTOOLIK
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99771-0009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-955-2442
Provider Business Practice Location Address Fax Number:
907-955-2506
Provider Enumeration Date:
11/23/2011