Provider First Line Business Practice Location Address:
1208 NORTH 18TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71201-5430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-322-2020
Provider Business Practice Location Address Fax Number:
318-387-4242
Provider Enumeration Date:
05/01/2007