Provider First Line Business Practice Location Address:
11962 COURSEY 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:
70816-4405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-291-3636
Provider Business Practice Location Address Fax Number:
225-291-3616
Provider Enumeration Date:
12/29/2006