Provider First Line Business Practice Location Address:
285 S ENGLEWOOD DR
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:
70810-5004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-603-7427
Provider Business Practice Location Address Fax Number:
225-926-7856
Provider Enumeration Date:
01/24/2010