Provider First Line Business Practice Location Address:
5241 HIGHLAND 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:
70808-6547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-769-2585
Provider Business Practice Location Address Fax Number:
225-757-9298
Provider Enumeration Date:
08/31/2006