| NPI | 1508037870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD W WILDE Clinic Director 479-986-5150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center Developmental Disabilities (Licence: AR 25537) |
| Enumeration Date | 2008-03-14 |
| Last Update Date | 2008-03-14 |