Provider First Line Business Practice Location Address:
1551 CB TEMPLE SR. ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENTWOOD
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-383-9139
Provider Business Practice Location Address Fax Number:
225-336-5431
Provider Enumeration Date:
05/10/2007