NPI | 1356671838 |
---|---|
Entity Type | Organization |
Authorized Contact | MICHELLE ECKERT Owner 870-534-4188 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: AR E2626) |
Enumeration Date | 2010-01-06 |
Last Update Date | 2010-01-06 |