Provider First Line Business Practice Location Address:
11401 INTERSTATE 30
Provider Second Line Business Practice Location Address:
BEHAVIORAL SERVICES
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72209-7042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-450-2690
Provider Business Practice Location Address Fax Number:
501-993-7036
Provider Enumeration Date:
11/21/2008