Provider First Line Business Practice Location Address:
244 TURNER AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARKSDALEAFB
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-747-1919
Provider Business Practice Location Address Fax Number:
318-747-1984
Provider Enumeration Date:
05/23/2007