Provider First Line Business Practice Location Address:
9800 AIRLINE HWY STE 241
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:
70816-8195
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-244-6012
Provider Business Practice Location Address Fax Number:
225-960-6669
Provider Enumeration Date:
05/11/2026