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Organization

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Organization subpart
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Provider details

NPI number
Authorized official
TINAMARIE BUFFINGTON (ADMINISTRATOR)
(907) 982-9287
Entity
Organization

Contact information

Practice address
590 N CINDY CIR, WASILLA, AK 99654-6836
(907) 982-9287
Mailing address
590 N CINDY CIR, WASILLA, AK 99654-6836
(907) 982-9287

Taxonomy

Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
100944
AK

Other

Enumeration date
09/28/2012
Last updated
09/28/2012
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