Provider First Line Business Practice Location Address:
705 PLANK RD
Provider Second Line Business Practice Location Address:
HIGHWAY 128
Provider Business Practice Location Address City Name:
ST. JOSEPH
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-766-4563
Provider Business Practice Location Address Fax Number:
318-766-4522
Provider Enumeration Date:
09/17/2019