Provider First Line Business Practice Location Address:
112 FOREST STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAIN DEALING
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-326-7272
Provider Business Practice Location Address Fax Number:
318-326-7282
Provider Enumeration Date:
10/27/2006