Provider First Line Business Practice Location Address:
11848 S. HARRELL'S FERRY RD.
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70816-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-361-0089
Provider Business Practice Location Address Fax Number:
225-361-0386
Provider Enumeration Date:
08/04/2011