Individual
BRACK R PONDEXTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4323 JEFFERSON AVE, TEXARKANA, AR 71854-1515
(870) 773-0700
(870) 773-0705
Mailing address
5537 BLEAUX AVE, SPRINGDALE, AR 72762-0737
(479) 872-5580
(479) 872-5581
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
10/04/2010
Last updated
10/04/2010
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