Provider First Line Business Practice Location Address:
515 W WADDIL ST
Provider Second Line Business Practice Location Address:
POST OFFICE BOX 307
Provider Business Practice Location Address City Name:
MARKSVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71351-2648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-253-5141
Provider Business Practice Location Address Fax Number:
318-240-8735
Provider Enumeration Date:
06/30/2010