Provider First Line Business Practice Location Address:
34972 OLD LA HIGHWAY 16 STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENHAM SPRINGS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70706-0573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-791-4225
Provider Business Practice Location Address Fax Number:
225-243-7957
Provider Enumeration Date:
11/19/2013