Individual
ELIJAH GOOD-FARM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
436 N MAIN ST, WASILLA, AK 99654-7018
(907) 376-8020
Mailing address
436 N MAIN ST, WASILLA, AK 99654-7018
(907) 376-8020
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
116274
AK
Other
Enumeration date
07/09/2018
Last updated
07/09/2018
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