Provider First Line Business Practice Location Address:
124 SCHOOL RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSE BUD
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-556-5152
Provider Business Practice Location Address Fax Number:
501-556-6001
Provider Enumeration Date:
01/22/2009