Provider First Line Business Practice Location Address:
640 DR. MICHAEL DEBAKEY DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70601-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-562-1000
Provider Business Practice Location Address Fax Number:
337-439-8829
Provider Enumeration Date:
01/20/2006