| NPI | 1013905587 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARA J. PETERS Practice Administrator 479-521-1484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AR C7126) |
| Additional Taxonomies | 208600000X Surgery (Licence: AR E0751) |
| 208600000X Surgery (Licence: AR E3076) | |
| 208D00000X General Practice (Licence: AR N8290) | |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2009-11-10 |