Provider First Line Business Practice Location Address:
628 N. FOURTH STREET
Provider Second Line Business Practice Location Address:
BIN 3
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-342-9500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/28/2013