Provider First Line Business Practice Location Address:
2000 CENTURYTEL CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOSSIER CITY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71112-4586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-752-2847
Provider Business Practice Location Address Fax Number:
318-741-9032
Provider Enumeration Date:
07/15/2006