Provider First Line Business Practice Location Address:
9613 PLANK ROAD
Provider Second Line Business Practice Location Address:
SUITE O
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-683-1230
Provider Business Practice Location Address Fax Number:
225-683-9691
Provider Enumeration Date:
01/30/2008