Provider First Line Business Practice Location Address:
900 OLD HWY 70 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DIERKS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-286-2191
Provider Business Practice Location Address Fax Number:
870-286-2450
Provider Enumeration Date:
03/22/2007