Provider First Line Business Practice Location Address:
824 LOUISIANA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOGALUSA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70427-3331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-732-4848
Provider Business Practice Location Address Fax Number:
985-732-9898
Provider Enumeration Date:
11/21/2011