Provider First Line Business Practice Location Address:
2129 E BERT KOUNS INDUSTRIAL LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71105-5327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-797-1873
Provider Business Practice Location Address Fax Number:
318-797-8892
Provider Enumeration Date:
09/16/2009