Provider First Line Business Practice Location Address:
2001 MILLERVILLE RD
Provider Second Line Business Practice Location Address:
TARGET PHARMACY STORE NUMBER T-2089
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70816-1408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-275-2109
Provider Business Practice Location Address Fax Number:
225-275-2109
Provider Enumeration Date:
06/17/2011