Provider First Line Business Practice Location Address:
9207 HIGHWAY 71 S
Provider Second Line Business Practice Location Address:
STE 9
Provider Business Practice Location Address City Name:
FORT SMITH
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72916-9117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-434-6140
Provider Business Practice Location Address Fax Number:
479-434-6144
Provider Enumeration Date:
10/05/2005