Provider First Line Business Practice Location Address:
9111 INTERLINE AVE STE 17A
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:
70809-1979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-615-7282
Provider Business Practice Location Address Fax Number:
225-615-7469
Provider Enumeration Date:
01/22/2014