Provider First Line Business Practice Location Address:
3839 W CONGRESS ST
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70506-6000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-984-0178
Provider Business Practice Location Address Fax Number:
337-981-5421
Provider Enumeration Date:
09/21/2006