Provider First Line Business Practice Location Address:
8150 JEFFERSON HWY
Provider Second Line Business Practice Location Address:
SUITE B
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-922-7044
Provider Business Practice Location Address Fax Number:
225-922-7046
Provider Enumeration Date:
08/20/2009