Provider First Line Business Practice Location Address:
516 EAST AIRLINE HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE D
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-359-2527
Provider Business Practice Location Address Fax Number:
985-359-4102
Provider Enumeration Date:
12/17/2007