Provider First Line Business Practice Location Address:
2400 HOSPITAL DRIVE
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
BOSSIER CITY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71111-2387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-212-8946
Provider Business Practice Location Address Fax Number:
318-212-7995
Provider Enumeration Date:
05/29/2007