Provider First Line Business Practice Location Address:
11300 ROBERTS BLVD
Provider Second Line Business Practice Location Address:
CHAFFEE CROSSING CLINIC
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-434-6205
Provider Business Practice Location Address Fax Number:
479-434-6210
Provider Enumeration Date:
06/07/2006