Provider First Line Business Practice Location Address:
1900 LAMY LN
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71201-9207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-322-2639
Provider Business Practice Location Address Fax Number:
318-322-2419
Provider Enumeration Date:
11/03/2006