Provider First Line Business Practice Location Address:
606 W. 11TH AVE.
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-590-4061
Provider Business Practice Location Address Fax Number:
985-231-4727
Provider Enumeration Date:
09/26/2012