Provider First Line Business Practice Location Address:
650 PERSHING AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUNKLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-346-8400
Provider Business Practice Location Address Fax Number:
318-346-6206
Provider Enumeration Date:
10/01/2007