Provider First Line Business Practice Location Address:
7278 HIGHLAND RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70808-6600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-367-1022
Provider Business Practice Location Address Fax Number:
225-612-6743
Provider Enumeration Date:
01/06/2017