| NPI | 1952652034 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINAMARIE BUFFINGTON Administrator 907-982-9287 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: AK 100944) |
| Enumeration Date | 2012-09-28 |
| Last Update Date | 2012-09-28 |