Provider First Line Business Practice Location Address:
HWY 560 GUM SPRING RD
Provider Second Line Business Practice Location Address:
WINN CORRECTIONAL CENTER
Provider Business Practice Location Address City Name:
WINNFIELD
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-628-3971
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/20/2006