Provider First Line Business Practice Location Address:
1301 W UNIVERSITY AVE
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:
70506-3466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-521-7900
Provider Business Practice Location Address Fax Number:
337-521-7901
Provider Enumeration Date:
12/19/2012