Provider First Line Business Practice Location Address:
25820 LA HIGHWAY 16
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENHAM SPRINGS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70726-5758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-369-6929
Provider Business Practice Location Address Fax Number:
225-369-6926
Provider Enumeration Date:
12/04/2014