| NPI | 1932556461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN GREGORY GIBBONS Owner 479-883-0240 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: AR E-3378) |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2016-05-13 |