Provider First Line Business Practice Location Address:
3402 BAKER BLVD
Provider Second Line Business Practice Location Address:
SUITE A2
Provider Business Practice Location Address City Name:
BAKER
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-803-3922
Provider Business Practice Location Address Fax Number:
225-223-6021
Provider Enumeration Date:
04/30/2007