Provider First Line Business Practice Location Address:
2514 BERT KOUNS INDUSTRIAL LOOP
Provider Second Line Business Practice Location Address:
PHYSICIANS PLAZA #9
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71118-3146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-688-5710
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2007