Provider First Line Business Practice Location Address:
2400 S. 48TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINDALE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-443-7105
Provider Business Practice Location Address Fax Number:
479-443-2519
Provider Enumeration Date:
05/31/2007