Provider First Line Business Practice Location Address:
700 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
STUBBS HALL 120 G
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-348-9269
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2015