Provider First Line Business Practice Location Address:
1435 E. CARROLL ST.
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
COUSHATTA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-932-8661
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2009