Provider First Line Business Practice Location Address:
400 N PECAN ST
Provider Second Line Business Practice Location Address:
CASTLEBERRY ELEMENTARY SCHOOL
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72112-4075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-523-1341
Provider Business Practice Location Address Fax Number:
870-523-1341
Provider Enumeration Date:
10/19/2009