| NPI | 1881134740 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW JOSEPH SHANNON President/CFO 501-339-6067 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MS 18668) |
| Enumeration Date | 2017-02-26 |
| Last Update Date | 2017-02-26 |