Provider First Line Business Practice Location Address:
6152 HWY 202 EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLIPPIN
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-453-4603
Provider Business Practice Location Address Fax Number:
870-453-1900
Provider Enumeration Date:
10/14/2005