| NPI | 1447483185 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY S BEALLIS Owner 479-459-5382 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: AR MC-2708) |
| Enumeration Date | 2009-08-28 |
| Last Update Date | 2021-11-04 |