Provider First Line Business Practice Location Address:
401 DOCTOR MICHAEL DEBAKEY DR STE 301
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:
70601-5864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-478-9331
Provider Business Practice Location Address Fax Number:
337-478-9828
Provider Enumeration Date:
04/22/2022