Provider First Line Business Practice Location Address:
311 LOUISIANA AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOGALUSA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-417-5250
Provider Business Practice Location Address Fax Number:
225-341-8756
Provider Enumeration Date:
12/31/2018