Provider First Line Business Practice Location Address:
711 DOCTOR MICHAEL DEBAKEY DR STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70601-5785
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-312-8960
Provider Business Practice Location Address Fax Number:
337-312-8961
Provider Enumeration Date:
08/07/2020