Provider First Line Business Practice Location Address:
1317 W AIRLINE HWY
Provider Second Line Business Practice Location Address:
SUITE K
Provider Business Practice Location Address City Name:
LA PLACE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70068-3710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-651-4612
Provider Business Practice Location Address Fax Number:
985-651-4613
Provider Enumeration Date:
04/30/2008