Provider First Line Business Practice Location Address:
8230 SUMMA AVE STE C
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:
70809-3421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-757-0552
Provider Business Practice Location Address Fax Number:
225-763-9997
Provider Enumeration Date:
08/10/2007