| NPI | 1699909911 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA LYNN WHEAT Pa/Credentialing Clerk 501-354-4589 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2009-05-14 |
| Last Update Date | 2021-03-03 |