Provider First Line Business Practice Location Address:
1236 KNOXVILLE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARTBURG
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37887-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-346-6556
Provider Business Practice Location Address Fax Number:
423-346-7541
Provider Enumeration Date:
05/23/2005