Provider First Line Business Practice Location Address:
1800 E 70TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71105-5338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-798-9400
Provider Business Practice Location Address Fax Number:
318-798-3894
Provider Enumeration Date:
06/07/2007