Provider First Line Business Practice Location Address:
2771 HWY 11 EAST
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
LENOIR CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-988-1916
Provider Business Practice Location Address Fax Number:
865-988-1914
Provider Enumeration Date:
02/12/2007