Provider First Line Business Practice Location Address:
145 JAMES COMEAUX RD
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:
70508-3255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-261-1935
Provider Business Practice Location Address Fax Number:
337-261-1938
Provider Enumeration Date:
11/09/2006