Provider First Line Business Practice Location Address:
1400 CAMP ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70130-4208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-451-0490
Provider Business Practice Location Address Fax Number:
504-654-1088
Provider Enumeration Date:
02/28/2012