Provider First Line Business Practice Location Address:
4201 N UNIVERSITY AVE
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:
70520-3903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-896-8888
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2006