Provider First Line Business Practice Location Address:
1401 A JEFFERSON HIGHWAY
Provider Second Line Business Practice Location Address:
ACADEMIC CENTER, 1ST FLOOR
Provider Business Practice Location Address City Name:
JEFFERSON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-842-3260
Provider Business Practice Location Address Fax Number:
504-842-3193
Provider Enumeration Date:
04/15/2021