Provider First Line Business Practice Location Address:
7335 EAST PALMER-WASILLA HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE 1A
Provider Business Practice Location Address City Name:
PALMER
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-250-4450
Provider Business Practice Location Address Fax Number:
877-335-7623
Provider Enumeration Date:
12/14/2010