Provider First Line Business Practice Location Address:
1578 TAZEWELL RD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAZEWELL
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37879-3644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-526-5500
Provider Business Practice Location Address Fax Number:
423-626-5561
Provider Enumeration Date:
10/22/2007