Provider First Line Business Practice Location Address:
234 DR MICHAEL DEBAKEY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70601-5960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-439-8857
Provider Business Practice Location Address Fax Number:
337-433-1159
Provider Enumeration Date:
11/14/2005