Provider First Line Business Practice Location Address:
501 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71301-8124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-449-1666
Provider Business Practice Location Address Fax Number:
318-449-1783
Provider Enumeration Date:
06/21/2005