PEDIATRIC NUTRITION PROVIDER OF ARKANSAS
Suppliers at Edison Ave, Benton, AR

License number
Arkansas MG00511
Category
Suppliers
Type
Durable Medical Equipment & Medical Supplies
Owner
Name: MRS. NICOLE C MOTTO
Title: CO-OWNER
Phone: (501) 315-7337
Address
Address
920 Edison Ave SUITE 8, Benton, AR 72015
National Provider ID: 1265569453
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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PEDIATRIC NUTRITION PROVIDER OF ARKANSAS, INC

920 Edison Ave STE 8, Benton, AR 72015

Status:
Inactive
Registration:
Nov 8, 2002
State ID:
100220397
Business type:
For Profit Corporation
Presidents:
Wan S. Choi (John) (President),Leonard Gray (Vice-President),Wan S. Choi (President),...
Agent:
John Choi,920 Edison Ave STE 8, Benton, AR 72015 (Physical)
Filled under act:
Dom Bus Corp; 958 of 1987

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