Provider First Line Business Practice Location Address:
2700 W AIRLINE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA PLACE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70068-2920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-536-7860
Provider Business Practice Location Address Fax Number:
504-888-8730
Provider Enumeration Date:
05/30/2005