Provider First Line Business Practice Location Address:
2200 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARVEY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70058-4006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-367-4404
Provider Business Practice Location Address Fax Number:
504-367-4327
Provider Enumeration Date:
09/02/2011