Provider First Line Business Practice Location Address:
2495 SHREVEPORT HWY (VA MEDICAL CENTER)
Provider Second Line Business Practice Location Address:
MAIL CODE 112
Provider Business Practice Location Address City Name:
PINEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-466-4034
Provider Business Practice Location Address Fax Number:
575-397-1012
Provider Enumeration Date:
04/29/2014