Provider First Line Business Practice Location Address:
R.E.BARROW TREATMENT CENTER
Provider Second Line Business Practice Location Address:
LOUISIANA STATE PENITENTIARY
Provider Business Practice Location Address City Name:
ANGOLA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-655-2710
Provider Business Practice Location Address Fax Number:
225-655-2273
Provider Enumeration Date:
06/15/2006