Provider First Line Business Practice Location Address:
2632 HIGHWAY 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LABADIEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70372-2045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-526-1699
Provider Business Practice Location Address Fax Number:
985-526-6796
Provider Enumeration Date:
02/27/2007