Provider First Line Business Practice Location Address:
11736 NEWCASTLE AVE
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:
70816-8933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-892-2116
Provider Business Practice Location Address Fax Number:
225-293-4300
Provider Enumeration Date:
04/14/2010