Provider First Line Business Practice Location Address:
1717 WEST COWLES STREET
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:
99701-4803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-452-8251
Provider Business Practice Location Address Fax Number:
907-459-3837
Provider Enumeration Date:
06/26/2012