Provider First Line Business Practice Location Address:
9938 AIRLINE HWY
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:
70816-8100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-663-2881
Provider Business Practice Location Address Fax Number:
225-424-2233
Provider Enumeration Date:
04/12/2012