| NPI | 1902245160 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLORIA GOMEZ-VILLANUEVA Case Manager 907-222-5259 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: AK 5890375920) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2013-06-21 |