Provider First Line Business Practice Location Address:
180 INFIRMARY RD
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:
70803-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-578-0950
Provider Business Practice Location Address Fax Number:
225-578-1771
Provider Enumeration Date:
08/31/2009