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1255545372
LARRY WADE
BENTON, AR
NPI
1255545372
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Enumeration Date
2007-05-09
Last Update Date
2007-07-08
Business Address
-- LARRY WADE CMP
6701 HIGHWAY 67
BENTON, AR 72015-8909
Phone number: 501-315-3344
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Mailing Address
-- LARRY WADE CMP
PO BOX 1589
BENTON, AR 72018-1589
Phone number: 501-315-3344
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