Provider First Line Business Practice Location Address:
1720 E. REELFOOT AVENUE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
UNION CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38261-6048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-885-6600
Provider Business Practice Location Address Fax Number:
731-885-9239
Provider Enumeration Date:
11/16/2005