Provider First Line Business Practice Location Address:
1130 E MILLSAP RD
Provider Second Line Business Practice Location Address:
BALANCE ROAD CTR FOR COUNSELING & SW--BASEMENT STE
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72703-5150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-422-2280
Provider Business Practice Location Address Fax Number:
479-616-1618
Provider Enumeration Date:
09/12/2007