Provider First Line Business Practice Location Address:
PRIMARY CARE CLINIC
Provider Second Line Business Practice Location Address:
11C3/NLR 2200 FT. ROOTS DR
Provider Business Practice Location Address City Name:
NORTH LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-257-3347
Provider Business Practice Location Address Fax Number:
501-257-2026
Provider Enumeration Date:
08/21/2006