Provider First Line Business Practice Location Address:
8646 GOODWOOD BLVD
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:
70806-7912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-927-2225
Provider Business Practice Location Address Fax Number:
225-923-1742
Provider Enumeration Date:
10/29/2008