Provider First Line Business Practice Location Address:
700 PHOSPHOR AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-287-4160
Provider Business Practice Location Address Fax Number:
504-305-0454
Provider Enumeration Date:
05/27/2015