Provider First Line Business Practice Location Address:
1201 HIGHWAY 37 19E STE 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:
37643-4678
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-543-3002
Provider Business Practice Location Address Fax Number:
423-543-3006
Provider Enumeration Date:
07/05/2006