Provider First Line Business Practice Location Address:
CAREHERE CLINIC- NASG PORTLAND, TN
Provider Second Line Business Practice Location Address:
160 KIRBY DRIVE
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-221-5901
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/19/2019