Organization
FULL POTENTIAL
Active
Other names
Potential Horizon
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RYAN BRUCE RUSSELL (SPEECH THERAPY)
(501) 562-5400
Entity
Organization
Contact information
Practice address
4 PARK DR, BRYANT, AR 72022-2940
(201) 249-7508
Mailing address
8109 INTERSTATE 30, LITTLE ROCK, AR 72209-4840
(501) 562-5400
(501) 562-8577
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
SP#2073
AR
Other
Enumeration date
01/20/2012
Last updated
01/20/2012
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