Provider First Line Business Practice Location Address:
120 MARKET ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED BOILING SPRINGS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-699-4035
Provider Business Practice Location Address Fax Number:
615-699-4055
Provider Enumeration Date:
09/30/2008