Provider First Line Business Practice Location Address:
510 WEST MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINVIEW
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-272-3115
Provider Business Practice Location Address Fax Number:
479-272-3125
Provider Enumeration Date:
12/13/2006