Provider First Line Business Practice Location Address:
5800 W 10TH ST STE 300
Provider Second Line Business Practice Location Address:
ARKANSAS DHHS
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72204-1764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-661-2873
Provider Business Practice Location Address Fax Number:
501-280-4619
Provider Enumeration Date:
03/29/2007