COTTONWOOD CREEK CLINIC LLC
Osteopathic Medicine at Gardner Way, Wasilla, AK

License number
Alaska 1011473
Category
Osteopathic Medicine
Type
Internal Medicine
Owner
Name: RICHARD BLAKE
Title: OWNER
Phone: (907) 373-5950
Address
Address
1751 E Gardner Way SUITE D, Wasilla, AK 99654
National Provider ID: 1134523855
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

See more information about COTTONWOOD CREEK CLINIC LLC at bizstanding.com

Cottonwood Creek Clinic, LLC

1751 E Gardiner Way SUITE D, Wasilla, AK 99654

Registration:
Oct 7, 2014
State ID:
10024033
Business type:
Limited Liability Company
Expiration:
Perpetual
Members:
Richard W Blake (Member),Thomas W Lutz (Member)
Agent:
Rick Blake,375 W Scheelite Dr, Wasilla, AK 99654 (Mailing)
Next Report:
20160102

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