Provider First Line Business Practice Location Address:
5151 PLANK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70805-3501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-330-6622
Provider Business Practice Location Address Fax Number:
225-356-8163
Provider Enumeration Date:
09/22/2011