Provider First Line Business Practice Location Address:
601 HWY 52 BYPASS EAST
Provider Second Line Business Practice Location Address:
TN DEPT OF HEALTH
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-666-2142
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/26/2007