Individual
IDA ALICIA RUSSELL
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
424 N UNIVERSITY AVE, LITTLE ROCK, AR 72205-3109
(501) 661-0336
(501) 661-0412
Mailing address
3408 SILICA HEIGHTS RD, BENTON, AR 72015-5622
(501) 860-6601
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
293
AR
Other
Enumeration date
04/19/2006
Last updated
07/08/2007
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