Provider First Line Business Practice Location Address:
1111 N LOBDELL AVE STE E
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:
70806-8832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-932-9161
Provider Business Practice Location Address Fax Number:
225-932-9161
Provider Enumeration Date:
07/17/2006