Provider First Line Business Practice Location Address:
679 E AIRPORT AVE
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:
70806-6517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-926-2195
Provider Business Practice Location Address Fax Number:
225-926-2192
Provider Enumeration Date:
08/02/2005