Provider First Line Business Practice Location Address:
1141 21ST AVE SOUTH A-1302 MEDICAL CENTER NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37232-2765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-343-5955
Provider Business Practice Location Address Fax Number:
614-322-8990
Provider Enumeration Date:
05/16/2012