Provider First Line Business Practice Location Address:
11766 S HARRELLS FERRY RD
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:
70816-5304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-593-6587
Provider Business Practice Location Address Fax Number:
225-293-6597
Provider Enumeration Date:
05/13/2009