Provider First Line Business Practice Location Address:
19550 N. 10 ST BRENNAN BEHAVIOR GROUP
Provider Second Line Business Practice Location Address:
UNIT 1
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-833-6730
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2014