| NPI | 1992021190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL WAGGONER Owner 479-582-1212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: AR 2411) |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2015-08-12 |