Provider First Line Business Practice Location Address:
98 HIGHWAY 63B STE A
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MARKED TREE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72365-1614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-358-2484
Provider Business Practice Location Address Fax Number:
870-358-6337
Provider Enumeration Date:
11/15/2006