Provider First Line Business Practice Location Address:
1 SAINT MARY PL
Provider Second Line Business Practice Location Address:
ANESTHESIA DEPT
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71101-4343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-214-8600
Provider Business Practice Location Address Fax Number:
888-411-4191
Provider Enumeration Date:
11/10/2005