Provider First Line Business Practice Location Address:
222 OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37683-1526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-727-6319
Provider Business Practice Location Address Fax Number:
423-727-4164
Provider Enumeration Date:
06/14/2005