Provider First Line Business Practice Location Address:
200 LOUISVILLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71201-5824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-322-2223
Provider Business Practice Location Address Fax Number:
318-322-2267
Provider Enumeration Date:
01/19/2012