Provider First Line Business Practice Location Address:
10235 JEFFERSON HWY.
Provider Second Line Business Practice Location Address:
BUILDING #5
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:
225-292-7645
Provider Business Practice Location Address Fax Number:
225-292-0345
Provider Enumeration Date:
01/25/2007