IDA ALICIA RUSSELL

LITTLE ROCK, AR
NPI1700841038
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: AR  293)
Enumeration Date2006-04-19
Last Update Date2007-07-08
Business Address
-- IDA ALICIA RUSSELL ATC
424 N UNIVERSITY AVE
LITTLE ROCK, AR 72205-3109
Phone number: 501-661-0336
Mailing Address
-- IDA ALICIA RUSSELL ATC
3408 SILICA HEIGHTS RD
BENTON, AR 72015-5622
Phone number: 501-860-6601
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