Provider First Line Business Practice Location Address:
1005 W WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71701-3828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-836-9303
Provider Business Practice Location Address Fax Number:
870-837-1537
Provider Enumeration Date:
12/19/2006