Provider First Line Business Practice Location Address:
5825 AIRLINE HWY
Provider Second Line Business Practice Location Address:
EMERGENCY MEDICINE RESIDENCY BLDG
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-358-3940
Provider Business Practice Location Address Fax Number:
225-354-2015
Provider Enumeration Date:
07/05/2006