Provider First Line Business Practice Location Address:
502 W. LASALLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VILLE PLATTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-363-3750
Provider Business Practice Location Address Fax Number:
337-363-3753
Provider Enumeration Date:
10/02/2006