Provider First Line Business Practice Location Address:
605B MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71301-8127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-442-2232
Provider Business Practice Location Address Fax Number:
318-442-2192
Provider Enumeration Date:
05/25/2005