Provider First Line Business Practice Location Address:
109 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEACHVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72438-9097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-539-6831
Provider Business Practice Location Address Fax Number:
870-539-6681
Provider Enumeration Date:
01/16/2007