Provider First Line Business Practice Location Address:
1008 16TH AVENUE
Provider Second Line Business Practice Location Address:
SUITE 100 H JAMES JORDAN MD
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-456-4825
Provider Business Practice Location Address Fax Number:
907-456-4899
Provider Enumeration Date:
10/12/2006