Provider First Line Business Practice Location Address:
STADIUM BOULEVARD
Provider Second Line Business Practice Location Address:
SPORTS MEDICINE FOOTBALL STADIUM AT ARKANSAS STATE UNIV
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72467-0480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-972-3342
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2007