Provider First Line Business Practice Location Address:
1111 MEDICAL CENTER BLVD
Provider Second Line Business Practice Location Address:
SN513
Provider Business Practice Location Address City Name:
MARRERO
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70072-3151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-340-4000
Provider Business Practice Location Address Fax Number:
504-341-1212
Provider Enumeration Date:
07/28/2009