| NPI | 1962953810 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYDIA M PETERSEN Owner 907-376-7300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: AK 1042971) |
| Enumeration Date | 2016-10-16 |
| Last Update Date | 2016-12-30 |