Provider First Line Business Practice Location Address:
1112 PORT ARTHUR TER
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PATHOLOGY
Provider Business Practice Location Address City Name:
LEESVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71446-4656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-238-9133
Provider Business Practice Location Address Fax Number:
337-238-5311
Provider Enumeration Date:
05/04/2010