Provider First Line Business Practice Location Address:
1585 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT POLK
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71459-5102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-624-9333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/31/2009