Provider First Line Business Practice Location Address:
50 LOUIS PRIMA DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70433-5903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-892-8934
Provider Business Practice Location Address Fax Number:
985-892-8937
Provider Enumeration Date:
06/15/2010