Provider First Line Business Practice Location Address:
13360 COURSEY BLVD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70816-5024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-756-1998
Provider Business Practice Location Address Fax Number:
225-756-4337
Provider Enumeration Date:
05/03/2006