Provider First Line Business Practice Location Address:
7855 JEFFERSON HWY
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:
70809-1206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-214-3199
Provider Business Practice Location Address Fax Number:
225-214-8011
Provider Enumeration Date:
04/19/2010