Provider First Line Business Practice Location Address:
7600 UTAH AVENUE
Provider Second Line Business Practice Location Address:
BLDG 744
Provider Business Practice Location Address City Name:
FORT POLK
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71459-5359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-221-5002
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2026