Provider First Line Business Practice Location Address:
1010 W LASALLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VILLE PLATTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70586-3004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-363-1135
Provider Business Practice Location Address Fax Number:
337-363-1550
Provider Enumeration Date:
06/13/2012