Provider First Line Business Practice Location Address:
STUDENT HEALTH CENTER BUILDING
Provider Second Line Business Practice Location Address:
INFIRMARY DR ROOM 172 LOUISIANA STATE UNIVERSITY
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70803-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-578-5651
Provider Business Practice Location Address Fax Number:
225-578-7684
Provider Enumeration Date:
10/04/2016