Provider First Line Business Practice Location Address:
5000 HENNESSY BLVD
Provider Second Line Business Practice Location Address:
OUR LADY OF THE LAKE REGIONAL MEDICAL CENTER
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70808-4375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-765-7790
Provider Business Practice Location Address Fax Number:
630-734-1560
Provider Enumeration Date:
08/12/2005