Provider First Line Business Practice Location Address:
1301 CARTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37402-4412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-756-0122
Provider Business Practice Location Address Fax Number:
423-756-1784
Provider Enumeration Date:
06/09/2005