Provider First Line Business Practice Location Address:
J K HAYNES BLDG 170
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70813-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-771-3324
Provider Business Practice Location Address Fax Number:
225-771-2349
Provider Enumeration Date:
05/29/2007