Provider First Line Business Practice Location Address:
502 WEST CENTRAL AVENUE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-562-3537
Provider Business Practice Location Address Fax Number:
423-566-2212
Provider Enumeration Date:
04/10/2007