Provider First Line Business Practice Location Address:
808 NEW HIGHWAY 68
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
SWEETWATER
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37874-1904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-337-6141
Provider Business Practice Location Address Fax Number:
423-337-6142
Provider Enumeration Date:
11/03/2006