Provider First Line Business Practice Location Address:
512 PLANK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST JOSEPH
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-766-3269
Provider Business Practice Location Address Fax Number:
318-766-3634
Provider Enumeration Date:
01/23/2008