Provider First Line Business Practice Location Address:
1201 NORTH SERVICE ROAD EAST
Provider Second Line Business Practice Location Address:
WAL-MART PHARMACY
Provider Business Practice Location Address City Name:
RUSTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-251-0392
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2014