Provider First Line Business Practice Location Address:
124 W OLD ANDREW JOHNSON HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37760-1945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-475-2657
Provider Business Practice Location Address Fax Number:
865-475-2657
Provider Enumeration Date:
02/22/2008