Provider First Line Business Practice Location Address:
2120 BERT KOUNS INDUSTRIAL LOOP
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71118-3351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-687-9800
Provider Business Practice Location Address Fax Number:
318-687-4752
Provider Enumeration Date:
08/19/2006