NPI | 1508036146 |
---|---|
Entity Type | Organization |
Authorized Contact | SHELLY PERRIN Secretary 870-845-3725 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: AR 2365) |
Enumeration Date | 2008-03-11 |
Last Update Date | 2008-03-11 |