Graduated: 1995
NPI: 1679697577
Practice Locations (3)
19074 FITZGERALD LN
COVINGTON, LA 704357531
9857738773
19074 FITZGERALD LN EXT
COVINGTON, LA 704357531
5001 HWY 190 E SERVICE RD D4
COVINGTON, LA 704334949
9857738773
Source: CMS National Downloadable File, September 2026.