Provider First Line Business Practice Location Address:
2416 CONGRESS PKWY S
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:
37303-2822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-745-1988
Provider Business Practice Location Address Fax Number:
423-745-1515
Provider Enumeration Date:
07/31/2006