Provider First Line Business Practice Location Address:
2321 HIGHWAY 25E S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAZEWELL
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37879-5818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-626-3315
Provider Business Practice Location Address Fax Number:
423-626-0515
Provider Enumeration Date:
03/08/2006