Provider First Line Business Practice Location Address:
1500 21ST AVENUE SOUTH
Provider Second Line Business Practice Location Address:
VANDERBILT ORTHODONTIC CENTER
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37212-8224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-343-0633
Provider Business Practice Location Address Fax Number:
615-343-1830
Provider Enumeration Date:
12/21/2006