Provider First Line Business Practice Location Address:
5491 CREEKWOOD PARK BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LENOIR CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37772-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-988-6649
Provider Business Practice Location Address Fax Number:
865-988-6546
Provider Enumeration Date:
09/15/2005