Provider First Line Business Practice Location Address:
643 DR MICHAEL DEBAKEY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70601-5726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-475-6334
Provider Business Practice Location Address Fax Number:
337-475-6327
Provider Enumeration Date:
12/27/2017