Provider First Line Business Practice Location Address:
1907 JOHNSON STREET
Provider Second Line Business Practice Location Address:
JENNINGS OUTPATIENT CLINIC
Provider Business Practice Location Address City Name:
JENNINGS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70546-9998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-824-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2006