Provider First Line Business Practice Location Address:
11914 JUSTICE AVE
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:
70816-2372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-293-1387
Provider Business Practice Location Address Fax Number:
225-291-7133
Provider Enumeration Date:
01/11/2007