Provider First Line Business Practice Location Address:
149 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKDALE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71463-3034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-335-1360
Provider Business Practice Location Address Fax Number:
318-335-9918
Provider Enumeration Date:
08/10/2006