Provider First Line Business Practice Location Address:
52579 US STATE ROUTE 51
Provider Second Line Business Practice Location Address:
LALLIE KEMP
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-878-9421
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2012