Provider First Line Business Practice Location Address:
241 NORTH LA 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANZA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-694-3312
Provider Business Practice Location Address Fax Number:
225-694-0337
Provider Enumeration Date:
11/06/2007