Provider First Line Business Practice Location Address:
12329 INDUSTRIPLEX BLVD
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:
70809-5125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-663-8830
Provider Business Practice Location Address Fax Number:
225-410-7328
Provider Enumeration Date:
12/18/2007