Provider First Line Business Practice Location Address:
29150 HEALTH UNIT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VACHERIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70090-4221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-265-7910
Provider Business Practice Location Address Fax Number:
225-265-3278
Provider Enumeration Date:
10/20/2014