Provider First Line Business Practice Location Address:
1651 LOBDELL AVE
Provider Second Line Business Practice Location Address:
BLDG B STE 103
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70806-8252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-926-0032
Provider Business Practice Location Address Fax Number:
225-926-0049
Provider Enumeration Date:
11/13/2006