| NPI | 1922207828 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ESTES Owner 479-271-2273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: AR #1256) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2007-07-12 |