Provider First Line Business Practice Location Address:
1211 21ST AVE S
Provider Second Line Business Practice Location Address:
MEDICAL ARTS BUILDING, SUITE 114
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37212-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-936-1966
Provider Business Practice Location Address Fax Number:
615-936-0966
Provider Enumeration Date:
03/30/2007