Provider First Line Business Practice Location Address:
1169 HIGHWAY 19 STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SLAUGHTER
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70777-3404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-513-7155
Provider Business Practice Location Address Fax Number:
225-250-1407
Provider Enumeration Date:
12/22/2015