Provider First Line Business Practice Location Address:
300 S SCHOOL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DERMOTT
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71638-2127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-538-9720
Provider Business Practice Location Address Fax Number:
870-538-3710
Provider Enumeration Date:
05/14/2007