Provider First Line Business Practice Location Address:
8235 YMCA PLAZA DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70810-0939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-287-6856
Provider Business Practice Location Address Fax Number:
225-767-5051
Provider Enumeration Date:
06/17/2013