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1821122664
MARK JORDAN FANDUWARD
LITTLE ROCK, AR
NPI
1821122664
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Enumeration Date
2007-03-15
Last Update Date
2007-07-08
Business Address
-- MARK JORDAN FANDUWARD
6501 W 12TH ST
LITTLE ROCK, AR 72204-1511
Phone number: 501-666-8686
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Mailing Address
-- MARK JORDAN FANDUWARD
PO BOX 251970
LITTLE ROCK, AR 72225-1970
Phone number: 501-666-8686
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