Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2019-06-25
- Last updated
- 2019-07-08
Specialties
Licenses
- License AR
- OT-A1507
Location
- Practice location
- 1500 WILSON LOOP
- City
- WARD AR
- Postal code
- 721768656
- Phone
- 501-588-3211
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.