Provider First Line Business Practice Location Address:
21516 HIGHWAY 36
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABITA SPRINGS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70420-3906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-214-4000
Provider Business Practice Location Address Fax Number:
504-265-8605
Provider Enumeration Date:
07/26/2017