| NPI | 1508240029 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY ROBERT GALVIN Owner 907-227-7156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: AK 1023912) |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2015-07-14 |