Provider First Line Business Practice Location Address:
1 NORTH STADIUM DR BROUSSARD CENTER FOR ATHLETIC TRAIN
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:
70803-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-276-1694
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2023