Provider First Line Business Practice Location Address:
1564 LOBDELL AVE
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:
70806-8243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-925-2756
Provider Business Practice Location Address Fax Number:
225-925-2756
Provider Enumeration Date:
12/22/2006