Provider First Line Business Practice Location Address:
6800 GREENWELL SPRINGS RD
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:
70805-7436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-216-9442
Provider Business Practice Location Address Fax Number:
225-216-1751
Provider Enumeration Date:
10/07/2010