Provider First Line Business Practice Location Address:
711 DR MICHAEL DEBAKEY DR
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70601-5785
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-436-6100
Provider Business Practice Location Address Fax Number:
337-436-6190
Provider Enumeration Date:
01/04/2006