Registry details
Type
Individual
Primary specialty
Radiology, Diagnostic Radiology
Enumerated
Jun 22, 2005
License(s)
K9206 (TX)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 12553 | Beaumont, TX 77726-2553 | |
| LOCATION | 2810 AMBASSADOR CAFFERY PKWY | Lafayette, LA 70506-5906 | 409-466-3626 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.