Provider First Line Business Practice Location Address:
11848 S HARRELL'S FERRY RD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70816-2593
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-572-0953
Provider Business Practice Location Address Fax Number:
225-774-2947
Provider Enumeration Date:
03/18/2010