Provider First Line Business Practice Location Address:
1140 COLLEGE AVE LC COLLEGE POOL
Provider Second Line Business Practice Location Address:
C/O PE DEPT DR SPEARS
Provider Business Practice Location Address City Name:
PINEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-730-3632
Provider Business Practice Location Address Fax Number:
318-487-0417
Provider Enumeration Date:
05/24/2007