Provider First Line Business Practice Location Address:
7970 JEFFERSON HWY STE A
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:
70809-1388
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-248-0081
Provider Business Practice Location Address Fax Number:
225-248-0410
Provider Enumeration Date:
03/14/2006