Provider First Line Business Practice Location Address:
2300 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
BOSSIER CITY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71111-2394
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-746-4842
Provider Business Practice Location Address Fax Number:
318-746-2326
Provider Enumeration Date:
08/23/2006