Provider First Line Business Practice Location Address:
4028 HIGHWAY 90 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVONDALE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70094-2622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-436-2223
Provider Business Practice Location Address Fax Number:
504-436-2224
Provider Enumeration Date:
11/18/2005