Provider First Line Business Practice Location Address:
220 JOHNSTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70501-8059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-235-8007
Provider Business Practice Location Address Fax Number:
337-522-7543
Provider Enumeration Date:
01/11/2013