| NPI | 1275744773 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAPHNE BELL Administrator 870-532-2229 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CA 142154724) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2020-08-22 |