Provider First Line Business Practice Location Address:
2400 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 490
Provider Business Practice Location Address City Name:
BOSSIER CITY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71111-2385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-798-9400
Provider Business Practice Location Address Fax Number:
318-798-6785
Provider Enumeration Date:
10/25/2005