Provider First Line Business Practice Location Address:
31839 LA HIGHWAY 16 STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENHAM SPRINGS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70726-1423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-271-4995
Provider Business Practice Location Address Fax Number:
225-271-4945
Provider Enumeration Date:
09/24/2013