Provider First Line Business Practice Location Address:
800 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE B-2
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71201-6955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-791-3236
Provider Business Practice Location Address Fax Number:
318-325-8749
Provider Enumeration Date:
04/29/2011