Provider First Line Business Practice Location Address:
6554 FLORIDA BLVD
Provider Second Line Business Practice Location Address:
SUITE 246-D
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70806-4474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-924-0620
Provider Business Practice Location Address Fax Number:
225-924-0602
Provider Enumeration Date:
12/13/2005