Provider First Line Business Practice Location Address:
1033 N LOBDELL 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:
70806-2233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-231-2490
Provider Business Practice Location Address Fax Number:
225-231-2857
Provider Enumeration Date:
06/11/2007