Provider First Line Business Practice Location Address:
103 10TH ST
Provider Second Line Business Practice Location Address:
103 TENTH ST.
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71418-3306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-307-9937
Provider Business Practice Location Address Fax Number:
318-649-2387
Provider Enumeration Date:
01/27/2014