Provider First Line Business Practice Location Address:
735 W FIFTH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA PLACE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-652-9504
Provider Business Practice Location Address Fax Number:
985-652-3475
Provider Enumeration Date:
05/05/2006