| NPI | 1164491767 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES THEROLD MEREDITH Owner 870-633-4711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: AR MC0977) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2020-09-24 |