Provider First Line Business Practice Location Address:
1200 N 18TH ST
Provider Second Line Business Practice Location Address:
SUITE L
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71201-5459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-537-9773
Provider Business Practice Location Address Fax Number:
318-322-3139
Provider Enumeration Date:
12/14/2009