Provider First Line Business Practice Location Address:
1201 HIGHWAY 19 E BYPASS SUITE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-547-3224
Provider Business Practice Location Address Fax Number:
180-041-9156
Provider Enumeration Date:
06/05/2009