Provider First Line Business Practice Location Address:
LSU ATHLETICS
Provider Second Line Business Practice Location Address:
ATHLETIC ADMINISTRATION BLDG
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70803-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-578-4151
Provider Business Practice Location Address Fax Number:
225-578-3894
Provider Enumeration Date:
06/10/2014