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1104031665
SHASTA DAVIS
MALVERN, AR
NPI
1104031665
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Enumeration Date
2007-05-10
Last Update Date
2008-10-14
Business Address
SHASTA DAVIS CMP
1708 E PAGE AVE
MALVERN, AR 72104-4540
Phone number: 501-332-4437
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Mailing Address
SHASTA DAVIS CMP
PO BOX 1589
BENTON, AR 72018-1589
Phone number: 501-315-3344
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