Provider First Line Business Practice Location Address:
345 W RAILROAD AVE
Provider Second Line Business Practice Location Address:
PAUL'S PHARMACY
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-809-1515
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2011