Provider First Line Business Practice Location Address:
13828 COURSEY BLVD
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:
70817-1307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-752-4530
Provider Business Practice Location Address Fax Number:
225-752-4652
Provider Enumeration Date:
09/21/2006