Provider First Line Business Practice Location Address:
4360 NORTH ST
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:
70806-3326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-346-6715
Provider Business Practice Location Address Fax Number:
225-346-6753
Provider Enumeration Date:
06/02/2008