Provider First Line Business Practice Location Address:
2401 PRENTISS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70122-5329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-220-1263
Provider Business Practice Location Address Fax Number:
504-243-1903
Provider Enumeration Date:
05/29/2015