Provider First Line Business Practice Location Address:
MEADOW LANE
Provider Second Line Business Practice Location Address:
CENTRAL LOUISIANA STATE HOSPITAL UNIT 6
Provider Business Practice Location Address City Name:
PINEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71306-0118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-484-6400
Provider Business Practice Location Address Fax Number:
318-487-5703
Provider Enumeration Date:
08/16/2006