Provider First Line Business Practice Location Address:
7656 JEFFERSON HWY
Provider Second Line Business Practice Location Address:
SUITE: 1A
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70809-1101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-927-2455
Provider Business Practice Location Address Fax Number:
225-927-7921
Provider Enumeration Date:
03/28/2006