Provider First Line Business Practice Location Address:
4500 HIGHWAY 80
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAUGHTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71037-9422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-932-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/01/2007