Provider First Line Business Practice Location Address:
13800 OLD GENTILLY ROAD
Provider Second Line Business Practice Location Address:
USCG ISC NOLA HEALTH SERVICES DIVISION
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-253-6506
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2006