Provider First Line Business Practice Location Address:
1161 21ST AVE SOUTH 5302 MEDICAL CENTER NORTH CCC
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37203-5279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-875-3464
Provider Business Practice Location Address Fax Number:
615-322-2733
Provider Enumeration Date:
06/05/2011