Provider First Line Business Practice Location Address:
302 DULLES DRIVE
Provider Second Line Business Practice Location Address:
CRISIS AND REFERRAL
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70506-5004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-262-5565
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2007