Provider First Line Business Practice Location Address:
9456 JEFFERSON HWY
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70809-2883
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-292-1800
Provider Business Practice Location Address Fax Number:
225-292-1900
Provider Enumeration Date:
06/10/2009