Provider First Line Business Practice Location Address:
1500 W AIRLINE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA PLACE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70068-3725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-652-6677
Provider Business Practice Location Address Fax Number:
985-652-6337
Provider Enumeration Date:
09/12/2006