Provider First Line Business Practice Location Address:
32420 BOWIE ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE CASTLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70788-0008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-545-2226
Provider Business Practice Location Address Fax Number:
225-545-2220
Provider Enumeration Date:
10/31/2006