Provider First Line Business Practice Location Address:
1209 N 18TH ST
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:
71201-5429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-323-2242
Provider Business Practice Location Address Fax Number:
318-323-2298
Provider Enumeration Date:
10/27/2006