Provider First Line Business Practice Location Address:
11140 N HARRELLS FERRY RD
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:
70816-8307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-926-1838
Provider Business Practice Location Address Fax Number:
225-275-0930
Provider Enumeration Date:
01/15/2013