| NPI | 1174738397 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD EDWARD DIETZEN Physician 870-863-6444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: AR E-1069) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2008-01-18 |