Provider First Line Business Practice Location Address:
927 N. JAMES CAMPBELL BLVD.
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-388-5114
Provider Business Practice Location Address Fax Number:
931-388-5631
Provider Enumeration Date:
01/13/2006