Provider First Line Business Practice Location Address:
17050 MEDICAL CENTER DRIVE
Provider Second Line Business Practice Location Address:
PHYSICIAN PLAZA II 4TH FLOOR
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-755-3070
Provider Business Practice Location Address Fax Number:
225-755-3085
Provider Enumeration Date:
01/08/2007