Provider First Line Business Practice Location Address:
811 JAMES AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMERVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71241-2237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-368-2238
Provider Business Practice Location Address Fax Number:
318-368-2240
Provider Enumeration Date:
03/28/2006