Provider First Line Business Practice Location Address:
1005 E BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LENOIR CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-988-9004
Provider Business Practice Location Address Fax Number:
865-988-0042
Provider Enumeration Date:
01/18/2007