Provider First Line Business Practice Location Address:
8017 JEFFERSON HWY
Provider Second Line Business Practice Location Address:
SUITE B-4
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70809-1681
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-932-0052
Provider Business Practice Location Address Fax Number:
225-932-2353
Provider Enumeration Date:
01/15/2007