Provider First Line Business Practice Location Address:
330 LEE DR.
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:
70808-1601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-926-4780
Provider Business Practice Location Address Fax Number:
225-926-4783
Provider Enumeration Date:
09/27/2006