Provider First Line Business Practice Location Address:
6119 HIGHWAY 45
Provider Second Line Business Practice Location Address:
4
Provider Business Practice Location Address City Name:
FORT SMITH
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-649-2627
Provider Business Practice Location Address Fax Number:
479-649-2628
Provider Enumeration Date:
06/10/2006