Provider First Line Business Practice Location Address:
1121 1/2 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBYVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37160-2309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-735-6160
Provider Business Practice Location Address Fax Number:
931-735-6290
Provider Enumeration Date:
02/20/2006