| NPI | 1952998825 |
|---|---|
| Doing Business As | HSP FOUNTAIN LAKE SCHOOL BASED CLINIC |
| Entity Type | Organization |
| Authorized Contact | BRENDA LARIE SOUTHERLAND CFO 501-625-7500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2020-12-28 |
| Last Update Date | 2020-12-28 |