Provider First Line Business Practice Location Address:
1260 UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEWANEE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-598-4141
Provider Business Practice Location Address Fax Number:
931-598-5198
Provider Enumeration Date:
10/04/2005