Provider First Line Business Practice Location Address:
12351 INDUSTRIPLEX BLVD
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:
70809-5125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-926-4400
Provider Business Practice Location Address Fax Number:
225-246-9116
Provider Enumeration Date:
03/20/2009