Provider First Line Business Practice Location Address:
243 CURTISS RD
Provider Second Line Business Practice Location Address:
ST 100 (2AMDS/SGPF)
Provider Business Practice Location Address City Name:
BARKSDALE AFB
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71110-2425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-456-6418
Provider Business Practice Location Address Fax Number:
318-456-8065
Provider Enumeration Date:
04/28/2009