Provider First Line Business Practice Location Address:
EARL K. LONG HOSPITAL, LSU UNIT
Provider Second Line Business Practice Location Address:
5825 AIRLINE HWY
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-358-3938
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2006