Provider First Line Business Practice Location Address:
5615F JACKSON ST
Provider Second Line Business Practice Location Address:
SUITE A LOUISIANA PSYCHOLOGICAL SERVICES
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-442-0001
Provider Business Practice Location Address Fax Number:
318-442-0010
Provider Enumeration Date:
04/10/2007