ARKANSAS

PINE BLUFF, AR
NPI1255771531
Entity TypeOrganization
Authorized ContactJANA RENE FOLEY
Managing Member
501-690-1328
Organization Subpart ?No
Primary Taxonomy302F00000X Exclusive Provider Organization
Enumeration Date2013-07-01
Last Update Date2013-07-01
Business Address
ARKANSAS
412 W 6TH AVE
PINE BLUFF, AR 71601-4136
Phone number: 501-690-1328
Mailing Address
ARKANSAS
2011 HILLSBOROUGH LN
LITTLE ROCK, AR 72212-3730
Phone number: 501-690-1328