Provider First Line Business Practice Location Address:
8595 UNITED PLAZA BLVD
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:
70809-2251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-635-6943
Provider Business Practice Location Address Fax Number:
985-635-6948
Provider Enumeration Date:
10/13/2006