Provider First Line Business Practice Location Address:
1000 HIGHWAY 28
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JASPER
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37347-3638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-837-9500
Provider Business Practice Location Address Fax Number:
423-837-3333
Provider Enumeration Date:
10/27/2006