Provider First Line Business Practice Location Address:
1742 FALLS BLVD. SUITE 5
Provider Second Line Business Practice Location Address:
THE LOGAN CENTER
Provider Business Practice Location Address City Name:
WYNNE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72396
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-208-9333
Provider Business Practice Location Address Fax Number:
870-208-9229
Provider Enumeration Date:
12/28/2006