Provider First Line Business Practice Location Address:
3193 HIGHWAY 126
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOUNTVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-323-6471
Provider Business Practice Location Address Fax Number:
423-279-2813
Provider Enumeration Date:
07/18/2005