Provider First Line Business Practice Location Address:
1107 GOVERNMENT ST
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:
70802-4838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-343-0905
Provider Business Practice Location Address Fax Number:
225-343-9955
Provider Enumeration Date:
04/25/2012