Provider First Line Business Practice Location Address:
719 EAST AIRPORT AVENUM
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-924-5251
Provider Business Practice Location Address Fax Number:
225-924-5251
Provider Enumeration Date:
10/03/2006