Provider First Line Business Practice Location Address:
921 N LOBDELL AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70806-8811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-925-8222
Provider Business Practice Location Address Fax Number:
225-925-8001
Provider Enumeration Date:
10/30/2007