| NPI | 1376519454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL N MOODY Medical Doctor 870-895-2541 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AR MC0433) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2010-12-22 |