Provider First Line Business Practice Location Address:
1101 SOUTH TENTH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEESVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-239-9120
Provider Business Practice Location Address Fax Number:
337-239-9128
Provider Enumeration Date:
07/13/2006