Provider First Line Business Practice Location Address:
16777 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:
70816-3254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-761-8223
Provider Business Practice Location Address Fax Number:
225-761-5220
Provider Enumeration Date:
06/09/2015