Provider First Line Business Practice Location Address:
9403 HUNTINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENHAM SPRINGS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70726-2222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-664-5630
Provider Business Practice Location Address Fax Number:
225-664-0186
Provider Enumeration Date:
10/15/2007