Organization
INTERVENTIONAL AND DIAGNOSTIC RADIOLOGY OF SOUTH ARKANSAS, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRENDA WILSON (BUSINESS MANAGER)
(870) 862-1577
Entity
Organization
Contact information
Practice address
700 W GROVE ST, EL DORADO, AR 71730-4416
(870) 862-1577
(870) 862-5916
Mailing address
611 THOMPSON AVE, EL DORADO, AR 71730-4557
(870) 862-1577
(870) 862-5916
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
C5187
AR
Other
Enumeration date
12/14/2009
Last updated
12/14/2009
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