| NPI | 1356614556 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN BUELL President 479-521-7774 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: AR PC-055) |
| Enumeration Date | 2012-02-17 |
| Last Update Date | 2012-02-20 |