Provider First Line Business Practice Location Address:
213 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:
70601-5974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-202-5205
Provider Business Practice Location Address Fax Number:
337-429-8146
Provider Enumeration Date:
03/17/2025