Provider First Line Business Practice Location Address:
1830 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:
70068-3335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-653-9974
Provider Business Practice Location Address Fax Number:
985-653-9980
Provider Enumeration Date:
11/08/2006