Provider First Line Business Practice Location Address:
1986 EAST MAIN STREET
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:
337-369-6000
Provider Business Practice Location Address Fax Number:
337-369-6024
Provider Enumeration Date:
01/24/2006