Provider First Line Business Practice Location Address:
1304 DECATUR PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37303-2418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-745-1702
Provider Business Practice Location Address Fax Number:
423-745-1702
Provider Enumeration Date:
08/10/2006