Provider First Line Business Mailing Address:
PO BOX 52244
Provider Second Line Business Mailing Address:
THE INTENSIVIST GROUP, LLC
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-798-4539
Provider Business Mailing Address Fax Number:
318-798-4601