Provider First Line Business Practice Location Address:
8100 YMCA PLAZA DR
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:
70810-0916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-456-4419
Provider Business Practice Location Address Fax Number:
225-923-0111
Provider Enumeration Date:
02/23/2010