Provider First Line Business Practice Location Address:
ONE PRIME CARE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELMER
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-645-7932
Provider Business Practice Location Address Fax Number:
731-645-5195
Provider Enumeration Date:
08/20/2006