Provider First Line Business Practice Location Address:
AAHSD- TYLER BHC
Provider Second Line Business Practice Location Address:
302 DULLES DRIVE
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-262-4137
Provider Business Practice Location Address Fax Number:
337-262-4178
Provider Enumeration Date:
10/15/2010