Provider First Line Business Practice Location Address:
1100 ANDRE ST STE 300
Provider Second Line Business Practice Location Address:
YPS - CREDENTIALING
Provider Business Practice Location Address City Name:
NEW IBERIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70563-2159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-364-9225
Provider Business Practice Location Address Fax Number:
337-364-6094
Provider Enumeration Date:
02/04/2010