| NPI | 1124161716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD IVES Manager 907-452-8346 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: AK 903255) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2020-08-22 |