Provider First Line Business Practice Location Address:
1161 21ST AVE. SOUTH, S-3223 MCAL
Provider Second Line Business Practice Location Address:
VANDERBILT UNIVERSITY MEDICAL CENTER
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37232-2372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-322-6976
Provider Business Practice Location Address Fax Number:
615-343-2605
Provider Enumeration Date:
06/11/2007