Provider First Line Business Practice Location Address:
1770 PHYSICIANS PARK DR
Provider Second Line Business Practice Location Address:
NHDP
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70816-3222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-756-3713
Provider Business Practice Location Address Fax Number:
225-756-3819
Provider Enumeration Date:
08/24/2010