Provider First Line Business Practice Location Address:
2333 GOVERNMENT STREET
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:
70806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-343-1394
Provider Business Practice Location Address Fax Number:
225-336-0631
Provider Enumeration Date:
03/06/2007