Provider First Line Business Practice Location Address:
12805 HIGHWAY 28 EAST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PINEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-466-5151
Provider Business Practice Location Address Fax Number:
318-466-3535
Provider Enumeration Date:
01/27/2009