Provider First Line Business Practice Location Address:
305 W. MAIN STREET
Provider Second Line Business Practice Location Address:
NEA BAPTIST CLINIC
Provider Business Practice Location Address City Name:
TRUMANN
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-483-6131
Provider Business Practice Location Address Fax Number:
870-483-2573
Provider Enumeration Date:
06/16/2005