| NPI | 1669082392 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN VAN RAVENSWAAY Executive Director 907-868-1105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2020-08-07 |
| Last Update Date | 2020-08-07 |