Provider First Line Business Practice Location Address:
10105 PLANK RD.
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-683-9000
Provider Business Practice Location Address Fax Number:
225-683-7000
Provider Enumeration Date:
07/09/2008