Provider First Line Business Practice Location Address:
500 S 6TH ST
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
LEESVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71446-4442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-239-8000
Provider Business Practice Location Address Fax Number:
337-239-8003
Provider Enumeration Date:
01/15/2007