Provider First Line Business Practice Location Address:
2555 PHILLIPS FIELD RD
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:
99709-3933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-333-8769
Provider Business Practice Location Address Fax Number:
802-419-9122
Provider Enumeration Date:
06/16/2026