Provider First Line Business Practice Location Address:
1503 W ELK AVE
Provider Second Line Business Practice Location Address:
SUITE 12
Provider Business Practice Location Address City Name:
ELIZABETHTON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37643-2876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-547-9400
Provider Business Practice Location Address Fax Number:
423-547-9401
Provider Enumeration Date:
06/09/2006