Provider First Line Business Practice Location Address:
700 UNIVERSITY AVENUE
Provider Second Line Business Practice Location Address:
STUBBS HALL 211/212
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-680-3595
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2022