Provider First Line Business Practice Location Address:
22070 HIGHWAY 59
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABITA SPRINGS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-892-0879
Provider Business Practice Location Address Fax Number:
985-875-2384
Provider Enumeration Date:
05/23/2005