Provider First Line Business Practice Location Address:
200 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:
70508-3104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-264-9787
Provider Business Practice Location Address Fax Number:
337-264-9506
Provider Enumeration Date:
06/09/2006