Provider First Line Business Practice Location Address:
PO BOX 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLIGAN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37682-0500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-461-8700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2025