| 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 |