Provider First Line Business Practice Location Address:
524 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:
70601-5725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-480-4948
Provider Business Practice Location Address Fax Number:
337-491-7195
Provider Enumeration Date:
05/31/2022