Provider First Line Business Practice Location Address:
935 SPRING CREEK RD STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST RIDGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37412-3994
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-756-4796
Provider Business Practice Location Address Fax Number:
423-267-7117
Provider Enumeration Date:
09/20/2006