Provider First Line Business Practice Location Address:
2223 JUSTICE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71201-3619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-323-0240
Provider Business Practice Location Address Fax Number:
318-322-7348
Provider Enumeration Date:
10/18/2006