Provider First Line Business Practice Location Address:
400 W MCKINLEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAUGHTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71037-9449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-949-3700
Provider Business Practice Location Address Fax Number:
318-949-3702
Provider Enumeration Date:
12/24/2013