Provider First Line Business Practice Location Address:
400 GEORGIA AVE
Provider Second Line Business Practice Location Address:
SUITE 16
Provider Business Practice Location Address City Name:
BOGALUSA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70427-3866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-516-9483
Provider Business Practice Location Address Fax Number:
985-732-3521
Provider Enumeration Date:
11/03/2006