Provider First Line Business Practice Location Address:
7278 HIGHLAND RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70808-6607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-329-1140
Provider Business Practice Location Address Fax Number:
225-329-1150
Provider Enumeration Date:
07/16/2013