Provider First Line Business Practice Location Address:
501 DR. MICHAEL DEBAKEY DR.
Provider Second Line Business Practice Location Address:
CREDENTIALING
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-312-8120
Provider Business Practice Location Address Fax Number:
337-312-8121
Provider Enumeration Date:
04/17/2018