Provider First Line Business Practice Location Address:
501 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 410
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71301-8124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-487-8181
Provider Business Practice Location Address Fax Number:
318-487-0595
Provider Enumeration Date:
08/23/2005