Provider First Line Business Practice Location Address:
1501 KINGS HIGHWAY
Provider Second Line Business Practice Location Address:
INTERNAL MEDICINE
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71130-3932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-626-0434
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2020