| NPI | 1972842433 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY RENEE BOLAM Practice Manager 907-248-8008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AK 940479) |
| Enumeration Date | 2013-02-04 |
| Last Update Date | 2013-12-20 |