Provider First Line Business Practice Location Address:
16 INFIRMARY ROAD
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:
70803-4375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-578-6716
Provider Business Practice Location Address Fax Number:
225-578-0596
Provider Enumeration Date:
02/02/2018