Provider First Line Business Practice Location Address:
6907 OLD HIGHWAY 165 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-649-6399
Provider Business Practice Location Address Fax Number:
318-649-2356
Provider Enumeration Date:
11/30/2015