Provider First Line Business Practice Location Address:
178 HIGHWAY 167 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALD KNOB
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72010-4058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-724-6207
Provider Business Practice Location Address Fax Number:
501-724-3305
Provider Enumeration Date:
03/31/2006