Provider First Line Business Practice Location Address:
1512 W KIRBY PL
Provider Second Line Business Practice Location Address:
DEPARTMENT OF EMERGENCY MEDICINE
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71103-3822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-675-7636
Provider Business Practice Location Address Fax Number:
318-675-7531
Provider Enumeration Date:
07/19/2006