Provider First Line Business Practice Location Address:
3 MEDICAL PLAZA PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINDEN
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71055-3330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-377-7134
Provider Business Practice Location Address Fax Number:
318-377-7098
Provider Enumeration Date:
10/04/2005