Provider First Line Business Practice Location Address:
11924 JUSTICE AVE STE B
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:
70816-2372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-308-4500
Provider Business Practice Location Address Fax Number:
225-224-3690
Provider Enumeration Date:
03/12/2025