Provider First Line Business Practice Location Address:
3001 E TEXAS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOSSIER CITY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-742-6600
Provider Business Practice Location Address Fax Number:
378-742-7207
Provider Enumeration Date:
09/21/2011