Provider First Line Business Practice Location Address:
248 BLANKENSHIP ROAD
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:
318-326-4623
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/13/2008