Provider First Line Business Practice Location Address:
11750 S HARRELLS FERRY RD STE A
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:
70816-2393
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-293-3989
Provider Business Practice Location Address Fax Number:
225-293-1262
Provider Enumeration Date:
10/10/2006