Provider First Line Business Practice Location Address:
501 EDGEWOOD DRIVE
Provider Second Line Business Practice Location Address:
PINEVILLE JUNIOR HIGH SCHOOL
Provider Business Practice Location Address City Name:
PINEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-640-1359
Provider Business Practice Location Address Fax Number:
318-640-1420
Provider Enumeration Date:
03/01/2012