| NPI | 1043565542 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVORY A KINSLOW Owner/Medical Director 870-234-5665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2024-03-04 |