Provider First Line Business Practice Location Address:
14500 PLANK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKER
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70714-5432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-774-2267
Provider Business Practice Location Address Fax Number:
225-778-0201
Provider Enumeration Date:
06/02/2006