| NPI | 1154350213 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY AYN DUVALL Billing Manager 479-967-7044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR C6448) |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2020-08-22 |