| NPI | 1003877036 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA RENEE HOLDER Medical Office Assistant 501-724-3110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: AR E2849) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2009-11-03 |