Provider First Line Business Practice Location Address:
7386 HIGHLAND RD
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:
70808-6609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-766-1840
Provider Business Practice Location Address Fax Number:
225-766-1864
Provider Enumeration Date:
10/26/2005