Provider First Line Business Practice Location Address:
516 WEEKS ST
Provider Second Line Business Practice Location Address:
BRUNETTE KING BLUE CLINIC APMC
Provider Business Practice Location Address City Name:
NEW IBERIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
150-823-2048
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2006