Provider First Line Business Practice Location Address:
1112 S 48TH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SPRINGDALE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72762-5848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-751-3900
Provider Business Practice Location Address Fax Number:
479-751-3011
Provider Enumeration Date:
09/14/2010