Provider First Line Business Practice Location Address:
160 N 8TH 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:
70802-5600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-383-5021
Provider Business Practice Location Address Fax Number:
225-383-5023
Provider Enumeration Date:
10/19/2006