Organization
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Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER R BROSNAN (DIRECTOR)
(337) 478-5611
Entity
Organization
Contact information
Practice address
1808 OAK PARK BLVD, LAKE CHARLES, LA 70601-8914
(337) 478-5611
(337) 478-5613
Mailing address
1808 OAK PARK BLVD, LAKE CHARLES, LA 70601-8914
(337) 478-5611
(337) 478-5613
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
399
LA
Other
Enumeration date
04/24/2008
Last updated
04/24/2008
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