Provider First Line Business Practice Location Address:
603 HIGHWAY 321 N UNIT 20 BLDG 4
Provider Second Line Business Practice Location Address:
LENOIR CITY PROF. PARK
Provider Business Practice Location Address City Name:
LENOIR CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37771-6575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-986-4582
Provider Business Practice Location Address Fax Number:
865-988-8398
Provider Enumeration Date:
07/01/2005