Provider First Line Business Practice Location Address:
1834 UPPERLINE 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:
70115-5548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-891-7330
Provider Business Practice Location Address Fax Number:
504-269-8612
Provider Enumeration Date:
03/19/2013