Individual
MS. MISTY ROSE KEITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
110 2ND AVE, FAIRBANKS, AK 99701-4809
(907) 452-7946
(907) 452-7942
Mailing address
1116 27TH AVE APT 1, FAIRBANKS, AK 99701-5611
(907) 750-3546
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
02/20/2012
Last updated
02/20/2012
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