Provider First Line Business Practice Location Address:
7777 HENNESSY BLVD
Provider Second Line Business Practice Location Address:
OUR LADY OF THE LAKE MED CNTR -- ER DEPT
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70808-4300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-447-2450
Provider Business Practice Location Address Fax Number:
405-341-9217
Provider Enumeration Date:
08/06/2008