Provider First Line Business Practice Location Address: 
NAVAL BRANCH HEALTH CLINIC BELLE CHASSE
    Provider Second Line Business Practice Location Address: 
400 RUSSELL AVE, BUILDING 41, ROOM 105C
    Provider Business Practice Location Address City Name: 
BELLE CHASSE
    Provider Business Practice Location Address State Name: 
LA
    Provider Business Practice Location Address Postal Code: 
70037
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
504-678-3679
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
12/31/2007