Provider First Line Business Practice Location Address:
8160 YMCA PLAZA DR
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70810-0916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-763-7770
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2005