Provider First Line Business Practice Location Address:
1655 LOUISVILLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-388-8880
Provider Business Practice Location Address Fax Number:
318-388-4561
Provider Enumeration Date:
01/13/2006