Provider First Line Business Practice Location Address:
6450 LA HIGHWAY 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INNIS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70747-4700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-492-3775
Provider Business Practice Location Address Fax Number:
225-492-3782
Provider Enumeration Date:
01/06/2014