Provider First Line Business Practice Location Address:
17000 MEDICAL CENTER DR
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:
70816-3246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-755-4820
Provider Business Practice Location Address Fax Number:
225-755-4386
Provider Enumeration Date:
08/11/2015