Provider First Line Business Practice Location Address:
2812 HIGHWAY 28 E
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:
71360-5715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-528-3355
Provider Business Practice Location Address Fax Number:
318-528-3356
Provider Enumeration Date:
11/14/2005