Provider First Line Business Practice Location Address:
505 S. HIGH SCHOOL AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LA PLACE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-220-8308
Provider Business Practice Location Address Fax Number:
985-651-4440
Provider Enumeration Date:
01/17/2008