Provider First Line Business Practice Location Address:
OUR LADY OF THE LAKE PHYSICIAN GROUP CARDIOTHORACIC SUR
Provider Second Line Business Practice Location Address:
7777 HENNESSY BOULEVARD SUITE 8001
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-490-7224
Provider Business Practice Location Address Fax Number:
225-490-7223
Provider Enumeration Date:
07/13/2005