Provider First Line Business Practice Location Address:
BRANCH MEDICAL CLINIC, NSA MID SOUTH
Provider Second Line Business Practice Location Address:
5722 INTEGRITY DR BLDG
Provider Business Practice Location Address City Name:
MILLINGTON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-874-2077
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/08/2006