Provider First Line Business Practice Location Address:
524 DR MICHAEL DEBAKEY DRIVE
Provider Second Line Business Practice Location Address:
ST PATRICK HOSOITAL
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70601-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-430-4455
Provider Business Practice Location Address Fax Number:
337-430-4454
Provider Enumeration Date:
10/28/2008