Provider First Line Business Practice Location Address:
12308 PLANK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70811-1037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-775-0585
Provider Business Practice Location Address Fax Number:
225-775-5706
Provider Enumeration Date:
02/28/2007