Provider First Line Business Practice Location Address:
600 E FLOURNOY LUCAS RD
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:
71115-3855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-797-1900
Provider Business Practice Location Address Fax Number:
318-797-1999
Provider Enumeration Date:
06/08/2006