Provider First Line Business Practice Location Address:
942 MCLEMORE DR
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:
70816-1802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-275-5303
Provider Business Practice Location Address Fax Number:
255-274-1028
Provider Enumeration Date:
11/18/2008