Provider First Line Business Practice Location Address:
9220 HIGHWAY 71 S
Provider Second Line Business Practice Location Address:
SUITE A5
Provider Business Practice Location Address City Name:
FORT SMITH
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72916-9117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-646-1245
Provider Business Practice Location Address Fax Number:
479-646-0592
Provider Enumeration Date:
09/04/2012