Provider First Line Business Practice Location Address:
921 LOBDELL AVE
Provider Second Line Business Practice Location Address:
SUITE B-4
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70806-7509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-246-8400
Provider Business Practice Location Address Fax Number:
225-246-8438
Provider Enumeration Date:
09/01/2011