Provider First Line Business Practice Location Address:
152 W MAIN ST STE B1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW IBERIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70560-3733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-367-0364
Provider Business Practice Location Address Fax Number:
337-367-0394
Provider Enumeration Date:
12/12/2006