Provider First Line Business Practice Location Address:
1453 E BERT KOUNS INDUSTRIAL LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71105-6800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-773-4903
Provider Business Practice Location Address Fax Number:
318-747-9994
Provider Enumeration Date:
07/08/2005