Provider First Line Business Practice Location Address:
9170 NEW HIGHWAY 68
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TELLICO PLAINS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37385-5397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-253-2823
Provider Business Practice Location Address Fax Number:
423-253-3247
Provider Enumeration Date:
11/30/2020