Provider First Line Business Practice Location Address:
7707 OLD HAMMOND HWY
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70809-1262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-926-6899
Provider Business Practice Location Address Fax Number:
225-926-7315
Provider Enumeration Date:
10/25/2006