Provider First Line Business Practice Location Address:
112 CHURCH ALLEY
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-369-6587
Provider Business Practice Location Address Fax Number:
337-369-3815
Provider Enumeration Date:
01/30/2007