Provider First Line Business Practice Location Address:
1 NORTH STADIUM DRIVE
Provider Second Line Business Practice Location Address:
BROUSSARD CENTER FOR ATHLETIC TRAINING
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-578-0681
Provider Business Practice Location Address Fax Number:
225-578-3924
Provider Enumeration Date:
09/20/2018