Provider First Line Business Practice Location Address:
6509 GOVERNMENT ST
Provider Second Line Business Practice Location Address:
STE. A
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70806-6238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-924-1824
Provider Business Practice Location Address Fax Number:
225-925-3168
Provider Enumeration Date:
09/25/2006