Provider First Line Business Practice Location Address:
16153 PERKINS RD STE C
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:
70810-3718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-802-2260
Provider Business Practice Location Address Fax Number:
225-425-5726
Provider Enumeration Date:
09/03/2026