| NPI | 1750579488 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE ROBERTSON Owner 479-890-5881 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: AR C6004) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2015-01-22 |