| NPI | 1295748960 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE JEAN BANNING-TIPPIN Office Manager/Physcian 479-495-7300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2013-05-15 |