Provider First Line Business Practice Location Address:
119 N. 13TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKDALE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-335-3390
Provider Business Practice Location Address Fax Number:
318-335-2907
Provider Enumeration Date:
05/07/2007