Provider First Line Business Practice Location Address:
601 DR. MICHAEL DEBAKEY DR.
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:
70601-5726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-304-4820
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/26/2010