Provider First Line Business Practice Location Address:
2840 WEST AIRLINE HWY.
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LA PLACE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-479-8000
Provider Business Practice Location Address Fax Number:
985-479-8002
Provider Enumeration Date:
11/20/2008