Provider First Line Business Practice Location Address:
1300 LAKEWOOD DRIVE
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
MORGAN CITY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-385-2710
Provider Business Practice Location Address Fax Number:
985-384-8217
Provider Enumeration Date:
12/16/2009