| NPI | 1851744239 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONIQUE PEDNAULT Sole Provider 907-444-1749 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: AK 102482) |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2016-07-20 |