Individual
ANNIAS TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2107 PLEASANT VALLEY DR, CONWAY, AR 72032-2544
(870) 995-5275
Mailing address
1111 MAIN ST # 974, CONWAY, AR 72032-5455
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
02/22/2025
Last updated
02/22/2025
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