Provider First Line Business Practice Location Address:
35194 OLD LA HIGHWAY 16
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENHAM SPRINGS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70706-0555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-665-6702
Provider Business Practice Location Address Fax Number:
225-664-7910
Provider Enumeration Date:
09/10/2021