Provider First Line Business Practice Location Address:
1640 COWLES ST.
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
FARIBANKS
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:
907-452-4768
Provider Business Practice Location Address Fax Number:
907-452-1009
Provider Enumeration Date:
08/02/2006