| NPI | 1457379364 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE CARLTON Administrator 870-932-2211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: AR AR3943) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2025-06-30 |