Provider First Line Business Practice Location Address:
3420 MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
STE 31
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-323-1362
Provider Business Practice Location Address Fax Number:
318-323-9875
Provider Enumeration Date:
12/13/2005