Provider First Line Business Practice Location Address:
800 MARSHALL ST # 512-9
Provider Second Line Business Practice Location Address:
DEPT. OF PEDIATRICS, SECTION OF ADOLESCENT MEDICINE
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72202-3510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-364-1849
Provider Business Practice Location Address Fax Number:
501-364-6728
Provider Enumeration Date:
07/18/2007