Provider First Line Business Practice Location Address:
601 DR MICHAEL DEBAKEY DR
Provider Second Line Business Practice Location Address:
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-436-1370
Provider Business Practice Location Address Fax Number:
337-436-1621
Provider Enumeration Date:
06/05/2018