Provider First Line Business Practice Location Address:
116 KENTUCKY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARAWAY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-482-3332
Provider Business Practice Location Address Fax Number:
870-482-3525
Provider Enumeration Date:
12/01/2006