NPI | 1255661732 |
---|---|
Entity Type | Organization |
Authorized Contact | RENEE BOGY Office Manager 870-534-4188 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: AR C4813) |
Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
Enumeration Date | 2010-01-06 |
Last Update Date | 2020-10-20 |