Provider First Line Business Practice Location Address:
4049 I-49 SOUTH SERVICE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OPELOUSAS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-942-2674
Provider Business Practice Location Address Fax Number:
337-948-1858
Provider Enumeration Date:
10/24/2006