Provider First Line Business Practice Location Address:
2001 HWY 18
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CITY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72437-0178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-237-8222
Provider Business Practice Location Address Fax Number:
870-237-4697
Provider Enumeration Date:
08/08/2008