Provider First Line Business Practice Location Address:
207 FLORIDA ST
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:
70801-1719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-341-1925
Provider Business Practice Location Address Fax Number:
225-612-5928
Provider Enumeration Date:
04/16/2009