Provider First Line Business Practice Location Address:
932 N 35TH ST
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:
70802-2007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-389-1422
Provider Business Practice Location Address Fax Number:
225-389-1421
Provider Enumeration Date:
10/18/2006