Provider First Line Business Practice Location Address:
3402 BAKER BLVD STE A-2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKER
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70714-2509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-775-0777
Provider Business Practice Location Address Fax Number:
225-775-0771
Provider Enumeration Date:
05/06/2009