| NPI | 1780697433 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRET RAYMOND Director Of Sales/Operations 479-845-0880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2020-08-22 |