Provider First Line Business Practice Location Address:
821 ELLIOTT ST
Provider Second Line Business Practice Location Address:
LSUHSC DEPARTMENT OF FAMILY PRACTICE
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71301-7732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-675-7737
Provider Business Practice Location Address Fax Number:
318-675-5666
Provider Enumeration Date:
05/25/2007