Provider First Line Business Practice Location Address: 
7003 CHAD COLLEY BLVD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
BARLING
    Provider Business Practice Location Address State Name: 
AR
    Provider Business Practice Location Address Postal Code: 
72923-3000
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
479-431-3500
    Provider Business Practice Location Address Fax Number: 
479-452-2098
    Provider Enumeration Date: 
09/24/2012