Provider First Line Business Practice Location Address:
2783 PLANK RD
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:
70805-8032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-356-9040
Provider Business Practice Location Address Fax Number:
225-358-9948
Provider Enumeration Date:
12/13/2007