Provider First Line Business Practice Location Address:
502 W CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA FOLLETTE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37766-3400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-562-5235
Provider Business Practice Location Address Fax Number:
423-563-7242
Provider Enumeration Date:
08/10/2006