Provider First Line Business Practice Location Address:
9536 AIRLINE HWY
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:
70815-5501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-926-3380
Provider Business Practice Location Address Fax Number:
225-928-4513
Provider Enumeration Date:
06/05/2012