Provider First Line Business Practice Location Address:
200 MEDICAL DR STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70538-4231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-907-6762
Provider Business Practice Location Address Fax Number:
337-907-6102
Provider Enumeration Date:
05/12/2006