Provider First Line Business Practice Location Address:
405 SAINT FERDINAND ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70802-6164
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-774-6761
Provider Business Practice Location Address Fax Number:
225-658-7630
Provider Enumeration Date:
03/08/2007