Provider First Line Business Practice Location Address:
11000 LIPSCOMB ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99516-1511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-244-4832
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2010