Provider First Line Business Practice Location Address:
430 W 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA PLACE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-652-9616
Provider Business Practice Location Address Fax Number:
985-652-9649
Provider Enumeration Date:
03/26/2007