Provider First Line Business Practice Location Address:
7996 HIGHWAY 19 E
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
ROAN MOUNTAIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37687-3377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-772-4167
Provider Business Practice Location Address Fax Number:
423-772-0178
Provider Enumeration Date:
03/22/2007