Provider First Line Business Practice Location Address:
810 N. 29TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-323-1223
Provider Business Practice Location Address Fax Number:
318-323-1224
Provider Enumeration Date:
06/16/2006