Provider First Line Business Practice Location Address:
1510 KUEBEL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70123-2266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-734-0563
Provider Business Practice Location Address Fax Number:
504-733-0179
Provider Enumeration Date:
08/25/2006