Provider First Line Business Practice Location Address:
2400 S. 48TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGDALE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-725-5224
Provider Business Practice Location Address Fax Number:
479-750-8967
Provider Enumeration Date:
02/20/2009