| NPI | 1922112390 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATHY ELAINE MYRICK Billing Clerk 870-532-2229 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: AR 5C587) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2020-08-22 |