Provider First Line Business Practice Location Address:
501 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
BOX 30141
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71301-8124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-442-5800
Provider Business Practice Location Address Fax Number:
318-442-1109
Provider Enumeration Date:
09/10/2008