| NPI | 1578643607 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONICA R FORMON Administrator 870-972-0411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: AR AR4148) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2010-11-10 |