Provider First Line Business Practice Location Address:
8017 JEFFERSON HWY
Provider Second Line Business Practice Location Address:
STE A2
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-405-7430
Provider Business Practice Location Address Fax Number:
225-928-8485
Provider Enumeration Date:
12/07/2012