Provider First Line Business Practice Location Address:
8280 YMCA PLAZA DR
Provider Second Line Business Practice Location Address:
STE. 3-A
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70810-0927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-757-0164
Provider Business Practice Location Address Fax Number:
225-767-8757
Provider Enumeration Date:
12/27/2006