Provider First Line Business Practice Location Address:
5920 BAYOU RAPIDES RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71303-7727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-201-0925
Provider Business Practice Location Address Fax Number:
504-335-0776
Provider Enumeration Date:
04/29/2026