| NPI | 1063514388 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERENCE BENJAMIN WILSON Staff Physician 501-257-2627 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: AR c4907) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2020-08-22 |