Provider First Line Business Practice Location Address:
524 CONCORDIA ST
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:
70806-6012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-429-6218
Provider Business Practice Location Address Fax Number:
225-465-5437
Provider Enumeration Date:
01/26/2026