Provider First Line Business Practice Location Address:
6711 HIGHWAY 1 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ADDIS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-364-3640
Provider Business Practice Location Address Fax Number:
225-364-3643
Provider Enumeration Date:
04/25/2011