Provider First Line Business Practice Location Address:
639 W LAFAYETTE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINNFIELD
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71483-3451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-648-2220
Provider Business Practice Location Address Fax Number:
318-648-2270
Provider Enumeration Date:
06/05/2006