Arkansas
NPI #1255771531 in Pine Bluff, Arkansas
Provider Information
- NPI Number
- 1255771531
- Entity Type
- Organization
- Organization Name
- Arkansas
- Primary Specialty
- Exclusive Provider Organization
- Enumeration Date
- Jul 1, 2013
- Last Updated
- Jul 1, 2013
Practice Location
- Address
- 412 W 6TH AVE
- City
- Pine Bluff
- State
- Arkansas
- ZIP Code
- 71601-4136
- Phone
- (501) 690-1328
Authorized Official
- Name
- MRS. JANA RENE FOLEY
- Title
- MANAGING MEMBER
- Phone
- (501) 690-1328
Specialties & Taxonomy Codes
| Specialty |
|---|
| Exclusive Provider Organization |
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