Provider First Line Business Practice Location Address:
4771 EASLEY ST
Provider Second Line Business Practice Location Address:
MILLINGTON MEDICAL CLINIC
Provider Business Practice Location Address City Name:
MILLINGTON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38053-1931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-873-2653
Provider Business Practice Location Address Fax Number:
901-873-0388
Provider Enumeration Date:
05/18/2007