Provider First Line Business Practice Location Address:
6502 HIGHWAY 182 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGAN CITY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70380-2034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-384-2126
Provider Business Practice Location Address Fax Number:
985-384-2120
Provider Enumeration Date:
09/26/2011