Provider First Line Business Practice Location Address:
213 DOCTOR MICHAEL DEBAKEY DRIVE
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:
70601-5974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-366-1850
Provider Business Practice Location Address Fax Number:
337-429-8141
Provider Enumeration Date:
07/04/2019