Provider First Line Business Practice Location Address:
745 SHREVEPORT BARKSDALE HWY
Provider Second Line Business Practice Location Address:
ATTENTION PHARMACY DEPT
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71105-2201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-861-3985
Provider Business Practice Location Address Fax Number:
318-861-4231
Provider Enumeration Date:
11/15/2006