Provider First Line Business Practice Location Address:
820 HIGH PLAINS AVE
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:
70810-4349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-810-3408
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2006