Provider First Line Business Practice Location Address:
142 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKDALE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71463-3035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-335-0303
Provider Business Practice Location Address Fax Number:
318-335-3033
Provider Enumeration Date:
06/23/2006