Provider First Line Business Practice Location Address:
1100 N. 5TH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEESVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71446-3464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-239-2020
Provider Business Practice Location Address Fax Number:
337-239-0755
Provider Enumeration Date:
09/14/2005