Provider First Line Business Practice Location Address:
2535 BERT KOUNS INDUSTRIAL LOOP
Provider Second Line Business Practice Location Address:
SUITE 211
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71118-3159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-687-4546
Provider Business Practice Location Address Fax Number:
318-683-5129
Provider Enumeration Date:
09/01/2006