Provider First Line Business Practice Location Address:
5800 W 10TH ST
Provider Second Line Business Practice Location Address:
SUITE 300 ARKANSAS DEPT OF HEALTH AND HUMAN SERVICES
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72204-1752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-661-2614
Provider Business Practice Location Address Fax Number:
501-661-2975
Provider Enumeration Date:
08/09/2006