Provider First Line Business Practice Location Address:
615 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLFAX
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71417-1414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-627-5428
Provider Business Practice Location Address Fax Number:
318-627-4187
Provider Enumeration Date:
09/27/2005