Provider First Line Business Practice Location Address:
1203 N 5TH ST
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:
71201-5317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-805-9000
Provider Business Practice Location Address Fax Number:
318-805-0345
Provider Enumeration Date:
06/26/2007