Provider First Line Business Practice Location Address:
180 NORTH 5TH STREET
Provider Second Line Business Practice Location Address:
BENSON DERMATOLOGY AND SKIN CANCER, LLC
Provider Business Practice Location Address City Name:
PONCHATOULA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-370-7546
Provider Business Practice Location Address Fax Number:
985-370-7765
Provider Enumeration Date:
03/30/2007