Provider First Line Business Practice Location Address:
4615 GOVERNMENT ST
Provider Second Line Business Practice Location Address:
BUILDING 2
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70806-5922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-922-0090
Provider Business Practice Location Address Fax Number:
225-925-1972
Provider Enumeration Date:
04/25/2013