Provider First Line Business Practice Location Address:
1005 EAST PARK
Provider Second Line Business Practice Location Address:
JIM CITTY FOOTBALL AND ATHLETIC TRAINING FACILITY
Provider Business Practice Location Address City Name:
SEARCY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-279-4165
Provider Business Practice Location Address Fax Number:
501-279-5906
Provider Enumeration Date:
04/28/2015