| NPI | 1407966005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBIN WEAVER Practice Manager 870-732-1191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2016-03-14 |