| NPI | 1366580912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE L O'FALLON Owner 907-770-7800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: AK 2342) |
| Additional Taxonomies | 174400000X Specialist (Licence: AK AA3566) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2008-06-26 |