Provider First Line Business Practice Location Address:
3700 HIGHWAY 79
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOMER
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71040-5114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-927-6133
Provider Business Practice Location Address Fax Number:
318-927-4200
Provider Enumeration Date:
09/30/2005