Provider First Line Business Practice Location Address:
21255 HIGHWAY 1
Provider Second Line Business Practice Location Address:
B2303 HEALTH SERVICES
Provider Business Practice Location Address City Name:
PLAQUEMINE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70764-5125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-353-8589
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2007