Individual
GLENN FONDAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
825 CENTER ST STE A, NEW IBERIA, LA 70560
(337) 551-4630
Mailing address
825 CENTER ST STE A, NEW IBERIA, LA 70560-5500
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/27/2017
Last updated
08/30/2018
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