Provider First Line Business Practice Location Address:
2239 HWY 65 AND 82 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE VILLAGE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-265-4400
Provider Business Practice Location Address Fax Number:
870-265-4401
Provider Enumeration Date:
04/17/2006