Provider First Line Business Practice Location Address:
2729 HWY 65 & 82 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE VILLAGE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71653-6136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-265-5351
Provider Business Practice Location Address Fax Number:
870-265-2091
Provider Enumeration Date:
12/03/2014