| NPI | 1699856872 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH DEWAYNE GEORGE Doctor Owner 870-238-8707 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: AR 1452) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2020-08-22 |