Provider First Line Business Practice Location Address:
1202 SOUTH TYLER STREET
Provider Second Line Business Practice Location Address:
ST TAMMANY PARISH HOSPITAL OPP
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-898-3774
Provider Business Practice Location Address Fax Number:
985-898-3778
Provider Enumeration Date:
07/13/2007