Provider First Line Business Practice Location Address:
7031 HIGHWAY 190 EAST SERVICE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70433-4955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-893-9464
Provider Business Practice Location Address Fax Number:
985-893-9465
Provider Enumeration Date:
12/05/2007