Provider First Line Business Practice Location Address:
106 CREEK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-426-2186
Provider Business Practice Location Address Fax Number:
865-426-9200
Provider Enumeration Date:
12/08/2006