Provider First Line Business Practice Location Address:
5800 W 10TH ST
Provider Second Line Business Practice Location Address:
STE 610 FREEWAY MEDICAL CENTER
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72204-1755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-661-9393
Provider Business Practice Location Address Fax Number:
501-663-4795
Provider Enumeration Date:
05/23/2006