Provider First Line Business Practice Location Address:
2639 NORTH 30TH STREET BATON ROUGE LA
Provider Second Line Business Practice Location Address:
2639 NORTH 30TH STREET
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-746-3227
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2023