Provider First Line Business Practice Location Address:
100 LA RUE FRANCE
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:
70508-3112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-237-2273
Provider Business Practice Location Address Fax Number:
337-237-1765
Provider Enumeration Date:
10/16/2006