Organization
STATELINE MEDICAL AR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRITTANY FOX (CO-OWNER)
(479) 650-9459
Entity
Organization
Contact information
Practice address
12204 W HIGHWAY 62, FARMINGTON, AR 72730-9560
(479) 561-2448
Mailing address
17 BELHAVEN VIEW CT, FORT SMITH, AR 72908-9063
(479) 650-9459
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
07/24/2018
Last updated
07/24/2018
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