Provider First Line Business Practice Location Address:
122 LE MEDICIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARENCRO
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70520-5641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-886-1008
Provider Business Practice Location Address Fax Number:
337-886-1008
Provider Enumeration Date:
09/30/2010