| NPI | 1881082238 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHESTER L CARLSON Medical Director 479-434-4948 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX Q2522) |
| Enumeration Date | 2015-01-07 |
| Last Update Date | 2015-01-07 |