Provider First Line Business Practice Location Address:
2225 LINE AVENUE
Provider Second Line Business Practice Location Address:
MID CITY PEDIATRICS
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-221-2225
Provider Business Practice Location Address Fax Number:
318-459-2955
Provider Enumeration Date:
04/23/2013