Provider First Line Business Practice Location Address:
10235 JEFFERSON 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:
70809-2728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-241-6400
Provider Business Practice Location Address Fax Number:
225-686-3979
Provider Enumeration Date:
07/24/2006