Provider First Line Business Practice Location Address:
939 S LEWIS ST
Provider Second Line Business Practice Location Address:
ATTENTION PHARMACY DEPT
Provider Business Practice Location Address City Name:
NEW IBERIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70560-6303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-364-1368
Provider Business Practice Location Address Fax Number:
318-365-8271
Provider Enumeration Date:
11/16/2006