Provider First Line Business Practice Location Address:
250 CUSHMAN ST
Provider Second Line Business Practice Location Address:
SUITE 2C
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99701-4640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-457-2700
Provider Business Practice Location Address Fax Number:
907-457-2707
Provider Enumeration Date:
03/21/2013