Individual
CHARLES ALAN WARDLAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
100 W HOLLY RD, JUNCTION CITY, AR 71749-9031
(870) 924-4575
Mailing address
PO BOX 269, JUNCTION CITY, AR 71749-0269
(870) 403-4648
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
694
AR
Other
Enumeration date
05/16/2017
Last updated
05/16/2017
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