Provider First Line Business Practice Location Address:
6000 KANAKANAK ROAD
Provider Second Line Business Practice Location Address:
MEDICAL STAFF OFFICE
Provider Business Practice Location Address City Name:
DILLLINGHAM
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99576-0130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-842-2037
Provider Business Practice Location Address Fax Number:
907-842-2039
Provider Enumeration Date:
02/01/2011