Provider First Line Business Practice Location Address:
2510 BERT KOUNS INDUSTRIAL LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71118-3119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-212-5200
Provider Business Practice Location Address Fax Number:
318-212-5595
Provider Enumeration Date:
05/25/2007