| NPI | 1467817148 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SOMA GHOSH Office Manager 870-391-5903 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: AR MC-3097) |
| Enumeration Date | 2015-12-22 |
| Last Update Date | 2015-12-22 |