Provider First Line Business Practice Location Address:
730 COLONIAL DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70806-6536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-924-7343
Provider Business Practice Location Address Fax Number:
225-924-7347
Provider Enumeration Date:
10/13/2009