Provider First Line Business Practice Location Address:
212 E. JEFFERSON
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKGROVE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-428-2310
Provider Business Practice Location Address Fax Number:
318-428-3424
Provider Enumeration Date:
01/05/2007