| NPI | 1902075807 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACIE ANN GONNER CEO 870-338-8447 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0401X Clinic/Center Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2008-02-25 |