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TERA GOODMAN

Developmental Disabilities >> Clinic/Center >> Ambulatory Health Care Facilities

Registrant NPI Number: 1215348552

Individual Registrant:
 TERA  GOODMAN 
Gender: F
Sole Proprietor

Location and contact information for practice:
15 BARBER DR  HARDY, AR 72542-9109 US
Tel: 870-994-3103  Fax: --

Contact information for business:
15 BARBER DR  HARDY, AR 72542-9109 US
Tel: --  Fax: --

Registration Information:
NPI: 1215348552
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y261QD1600XAmbulatory Health Care Facilities
Clinic/Center
Developmental Disabilities

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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