Provider First Line Business Practice Location Address:
16260 AIRLINE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRAIRIESVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-744-1111
Provider Business Practice Location Address Fax Number:
225-744-4919
Provider Enumeration Date:
10/16/2006