Provider First Line Business Practice Location Address:
2684 W HIGHWAY 11E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STRAWBERRY PLAINS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37871-3554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-933-4565
Provider Business Practice Location Address Fax Number:
865-932-9127
Provider Enumeration Date:
07/01/2005