Provider First Line Business Practice Location Address:
9213 INTERLINE AVE
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:
70809-1984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-259-2222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2026