Provider First Line Business Practice Location Address:
150 WEST PRIEN LAKE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70601-8578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-478-1700
Provider Business Practice Location Address Fax Number:
337-474-2449
Provider Enumeration Date:
05/01/2007