Provider First Line Business Practice Location Address:
607 W SCHOOL ST
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:
70605-2748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-436-8111
Provider Business Practice Location Address Fax Number:
337-436-8911
Provider Enumeration Date:
11/03/2005