Provider First Line Business Practice Location Address:
307 CARPENTER DAM ROAD
Provider Second Line Business Practice Location Address:
BLDG. L
Provider Business Practice Location Address City Name:
HOT SPRINGS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71901-8218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-623-6353
Provider Business Practice Location Address Fax Number:
501-321-4783
Provider Enumeration Date:
10/05/2006