| NPI | 1710934542 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL R BOHANNAN Administrator 870-541-3640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: AR AR3637) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2008-08-26 |