Provider First Line Business Practice Location Address:
600 E 3RD ST
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:
70501-6020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-232-8814
Provider Business Practice Location Address Fax Number:
337-234-8542
Provider Enumeration Date:
04/08/2006