Provider First Line Business Practice Location Address:
138 MCGHEE DRIVE
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:
70815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-284-7504
Provider Business Practice Location Address Fax Number:
225-272-0950
Provider Enumeration Date:
08/11/2010