| NPI | 1558452409 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA LYNN LOFTIS Owner 501-332-4979 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: AR 2905) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2020-08-22 |