Provider First Line Business Practice Location Address:
9160 US HIGHWAY 64 STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38002-3011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-213-0100
Provider Business Practice Location Address Fax Number:
901-213-0101
Provider Enumeration Date:
08/06/2014