| NPI | 1265544373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD EDWARD EDGERTON Administrator 501-955-1156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: AR MC2053) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-09-06 |