Provider First Line Business Practice Location Address:
307 3RD 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:
70801-1308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-400-9921
Provider Business Practice Location Address Fax Number:
225-400-9922
Provider Enumeration Date:
07/12/2010