Provider First Line Business Practice Location Address:
203 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YOUNGSVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70592
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-856-1001
Provider Business Practice Location Address Fax Number:
337-856-1002
Provider Enumeration Date:
09/22/2006