Provider First Line Business Practice Location Address:
3544 WEST ESPANADE AVE.
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-888-1185
Provider Business Practice Location Address Fax Number:
504-888-1180
Provider Enumeration Date:
10/13/2006