| 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 |