Provider First Line Business Practice Location Address:
1000 N 23RD 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:
70802-3337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-343-9505
Provider Business Practice Location Address Fax Number:
225-343-9141
Provider Enumeration Date:
04/18/2007