Provider First Line Business Practice Location Address:
BOX 92735
Provider Second Line Business Practice Location Address:
MCNEESE STATE UNIVERSITY
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70609-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-475-5206
Provider Business Practice Location Address Fax Number:
337-477-8964
Provider Enumeration Date:
10/16/2007