Provider First Line Business Practice Location Address:
2200 JEFFERSON HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70121-3822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-834-3144
Provider Business Practice Location Address Fax Number:
504-832-3909
Provider Enumeration Date:
06/03/2006