Provider First Line Business Practice Location Address:
4301 W. MARKHAM ST., SLOT 547-11
Provider Second Line Business Practice Location Address:
UNIV. OF AR. FOR MEDICAL SCIENCE/REHAB. SERVICES
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205-7199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-265-9027
Provider Business Practice Location Address Fax Number:
501-296-1216
Provider Enumeration Date:
06/10/2006