Provider First Line Business Practice Location Address:
13072 COURSEY BLVD.
Provider Second Line Business Practice Location Address:
BUILDING 4 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:
70816-2376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-291-6565
Provider Business Practice Location Address Fax Number:
225-291-6566
Provider Enumeration Date:
05/08/2007