Provider First Line Business Practice Location Address:
C/O CENTRAL STATE HOSPITAL, UNIT 6, MEADOW LANE
Provider Second Line Business Practice Location Address:
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:
318-484-6400
Provider Business Practice Location Address Fax Number:
318-487-5703
Provider Enumeration Date:
04/17/2006