Provider First Line Business Practice Location Address:
400 MEMPHIS STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOGALUSA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-730-2208
Provider Business Practice Location Address Fax Number:
985-730-2209
Provider Enumeration Date:
07/30/2006