Provider First Line Business Practice Location Address:
4141 N UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARENCRO
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70520-4204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-565-2692
Provider Business Practice Location Address Fax Number:
337-735-3045
Provider Enumeration Date:
06/07/2023