Provider First Line Business Practice Location Address:
1201 POWELL AVENUE
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:
71203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-322-6360
Provider Business Practice Location Address Fax Number:
318-361-3788
Provider Enumeration Date:
05/15/2007