Provider First Line Business Practice Location Address:
14635 S HARRELL'S FERRY ROAD
Provider Second Line Business Practice Location Address:
SUITE 3A
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70816-2961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-754-8888
Provider Business Practice Location Address Fax Number:
225-751-5847
Provider Enumeration Date:
02/06/2008