Provider First Line Business Practice Location Address:
700 JEFFERSON ST
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:
70501-6910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-233-4165
Provider Business Practice Location Address Fax Number:
337-237-6729
Provider Enumeration Date:
05/25/2007