Provider First Line Business Practice Location Address:
312 FITE AVE E
Provider Second Line Business Practice Location Address:
SMITH COUNTY HIGH SCHOOL
Provider Business Practice Location Address City Name:
CARTHAGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37030-1474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-714-1578
Provider Business Practice Location Address Fax Number:
615-735-9049
Provider Enumeration Date:
04/10/2006