Provider Information for 1841469632
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WARREN BRENT ROBY LAC
Sex: Male
NPI: 1841469632
Last Updated: 2017-01-12
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1841469632 | ||||||||||||
| Enumeration Date | 2008-02-26 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 2400 S. 48TH STREET SPRINGDALE, AR 72762 United States Phone: 479-750-2020 | Fax:479-750-4843 | ||||||||||||
| Primary Practice Address | 710 S HOLLY ST SILOAM SPRINGS, AR 72761-3304 United States Phone: 479-524-8618 | Fax:479-750-4843 | ||||||||||||
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