Provider First Line Business Practice Location Address:
MEADOW LANE
Provider Second Line Business Practice Location Address:
CLSH/RRTC UNIT #6
Provider Business Practice Location Address City Name:
PINEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71409-0212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-487-5191
Provider Business Practice Location Address Fax Number:
318-487-5184
Provider Enumeration Date:
08/23/2006