Provider First Line Business Practice Location Address:
512 E 6TH ST
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:
70427-4706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-732-0401
Provider Business Practice Location Address Fax Number:
985-732-0501
Provider Enumeration Date:
11/10/2011