Provider First Line Business Practice Location Address:
878 HIGHWAY 92 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANDRIDGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37725-4621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-397-1038
Provider Business Practice Location Address Fax Number:
865-397-6820
Provider Enumeration Date:
11/19/2009